|
OXFRD UNI TIB SZ:C RM 154723
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.00 |
| Max. Negotiated Rate |
$3,249.50 |
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,345.00
|
| Rate for Payer: Health Management Network Commercial |
$2,847.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,015.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,249.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,876.00
|
|
|
OXFRD UNI TIB SZ:C RM 154723
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.00 |
| Max. Negotiated Rate |
$3,249.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,675.00
|
| Rate for Payer: AlohaCare Medicare |
$2,546.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Devoted Health Medicare |
$2,814.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,546.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,345.00
|
| Rate for Payer: Health Management Network Commercial |
$2,847.50
|
| Rate for Payer: Humana Medicare |
$2,546.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,015.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,708.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,546.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,249.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,546.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,546.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,546.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,876.00
|
|
|
OXFRD UNI TIB SZ:D LM 154724
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,848.00 |
| Max. Negotiated Rate |
$3,201.00 |
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,310.00
|
| Rate for Payer: Health Management Network Commercial |
$2,805.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,970.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,201.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,848.00
|
|
|
OXFRD UNI TIB SZ:D LM 154724
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$3,201.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,650.00
|
| Rate for Payer: AlohaCare Medicare |
$2,508.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Devoted Health Medicare |
$2,772.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,508.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,310.00
|
| Rate for Payer: Health Management Network Commercial |
$2,805.00
|
| Rate for Payer: Humana Medicare |
$2,508.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,970.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,683.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,508.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,201.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,508.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,508.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,508.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,848.00
|
|
|
OXFRD UNI TIB SZ:E RM 154727
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.00 |
| Max. Negotiated Rate |
$3,201.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,650.00
|
| Rate for Payer: AlohaCare Medicare |
$2,508.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Devoted Health Medicare |
$2,772.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,508.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,310.00
|
| Rate for Payer: Health Management Network Commercial |
$2,805.00
|
| Rate for Payer: Humana Medicare |
$2,508.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,970.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,683.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,508.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,201.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,508.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,508.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,508.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,848.00
|
|
|
OXFRD UNI TIB SZ:E RM 154727
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,848.00 |
| Max. Negotiated Rate |
$3,201.00 |
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,310.00
|
| Rate for Payer: Health Management Network Commercial |
$2,805.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,970.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,201.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,848.00
|
|
|
OXFRD UNI TIB SZ:F RM 154776
|
Facility
|
OP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,675.00 |
| Max. Negotiated Rate |
$3,249.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,675.00
|
| Rate for Payer: AlohaCare Medicare |
$2,546.00
|
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Devoted Health Medicare |
$2,814.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,546.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,345.00
|
| Rate for Payer: Health Management Network Commercial |
$2,847.50
|
| Rate for Payer: Humana Medicare |
$2,546.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,015.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,708.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,546.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,249.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,546.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,546.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,546.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,876.00
|
|
|
OXFRD UNI TIB SZ:F RM 154776
|
Facility
|
IP
|
$3,350.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,876.00 |
| Max. Negotiated Rate |
$3,249.50 |
| Rate for Payer: Cash Price |
$2,010.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,345.00
|
| Rate for Payer: Health Management Network Commercial |
$2,847.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,015.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,249.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,876.00
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 10702020101
|
|
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
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687067011
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687067001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 10702020101
|
|
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
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687067011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$1.52
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$1.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.52
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.52
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
OXYBUTYNIN CHLORIDE 5 MG TABLET [5938]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687067001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$1.52
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$1.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$1.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.52
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.52
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 60687040677
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: AlohaCare Medicaid |
$11.00
|
| Rate for Payer: AlohaCare Medicare |
$16.72
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.90
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Humana Medicare |
$16.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.72
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.72
|
| Rate for Payer: University Health Alliance Commercial |
$16.04
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
NDC 64950035405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: AlohaCare Medicaid |
$11.00
|
| Rate for Payer: AlohaCare Medicare |
$16.72
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.90
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Humana Medicare |
$16.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.72
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.72
|
| Rate for Payer: University Health Alliance Commercial |
$16.04
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 64950035405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 60687040640
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 66689040150
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$19.76
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$21.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Humana Medicare |
$19.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.76
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.76
|
| Rate for Payer: University Health Alliance Commercial |
$18.95
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
NDC 60687040677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
IP
|
$26.00
|
|
|
Service Code
|
NDC 66689040150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.10 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
|
|
OXYCODONE 5 MG/5 ML ORAL SOLUTION [10813]
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
NDC 60687040640
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$25.22 |
| Rate for Payer: AlohaCare Medicaid |
$13.00
|
| Rate for Payer: AlohaCare Medicare |
$19.76
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Devoted Health Medicare |
$21.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.70
|
| Rate for Payer: Health Management Network Commercial |
$22.10
|
| Rate for Payer: Humana Medicare |
$19.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.76
|
| Rate for Payer: MDX Hawaii PPO |
$25.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.76
|
| Rate for Payer: University Health Alliance Commercial |
$18.95
|
|
|
OXYCODONE 5 MG TABLET [10814]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00406055262
|
|
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
|
|
|
OXYCODONE 5 MG TABLET [10814]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00406055223
|
|
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
|
|
|
OXYCODONE 5 MG TABLET [10814]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00406055262
|
|
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
|
|
