|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
NDC 64980032005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
NDC 64980032005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$153.52
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$169.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.90
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$153.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.52
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.52
|
| Rate for Payer: University Health Alliance Commercial |
$147.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
NDC 51672126705
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.70 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % DENTAL PASTE [8121]
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
NDC 51672126705
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$195.94 |
| Rate for Payer: AlohaCare Medicaid |
$101.00
|
| Rate for Payer: AlohaCare Medicare |
$153.52
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Devoted Health Medicare |
$169.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$153.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.90
|
| Rate for Payer: Health Management Network Commercial |
$171.70
|
| Rate for Payer: Humana Medicare |
$153.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$103.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$153.52
|
| Rate for Payer: MDX Hawaii PPO |
$195.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$153.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$153.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$153.52
|
| Rate for Payer: University Health Alliance Commercial |
$147.24
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION [8116]
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 00713067653
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: AlohaCare Medicaid |
$157.50
|
| Rate for Payer: AlohaCare Medicare |
$239.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Devoted Health Medicare |
$264.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$299.25
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Humana Medicare |
$239.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.40
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.40
|
| Rate for Payer: University Health Alliance Commercial |
$229.60
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION [8116]
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 42571038519
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION [8116]
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
NDC 00713067653
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % LOTION [8116]
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
NDC 42571038519
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$157.50 |
| Max. Negotiated Rate |
$305.55 |
| Rate for Payer: AlohaCare Medicaid |
$157.50
|
| Rate for Payer: AlohaCare Medicare |
$239.40
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Devoted Health Medicare |
$264.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$299.25
|
| Rate for Payer: Health Management Network Commercial |
$267.75
|
| Rate for Payer: Humana Medicare |
$239.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$283.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$160.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.40
|
| Rate for Payer: MDX Hawaii PPO |
$305.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.40
|
| Rate for Payer: University Health Alliance Commercial |
$229.60
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
NDC 00168000480
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.50 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
NDC 00168000415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 45802006435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
NDC 00168000480
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$29.10 |
| Rate for Payer: AlohaCare Medicaid |
$15.00
|
| Rate for Payer: AlohaCare Medicare |
$22.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Devoted Health Medicare |
$25.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.50
|
| Rate for Payer: Health Management Network Commercial |
$25.50
|
| Rate for Payer: Humana Medicare |
$22.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.80
|
| Rate for Payer: MDX Hawaii PPO |
$29.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.80
|
| Rate for Payer: University Health Alliance Commercial |
$21.87
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
NDC 45802006436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 51672128201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 67877025115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.90
|
| Rate for Payer: MDX Hawaii PPO |
$20.37
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 45802006435
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: AlohaCare Medicaid |
$7.00
|
| Rate for Payer: AlohaCare Medicare |
$10.64
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$11.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.30
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Humana Medicare |
$10.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.64
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.64
|
| Rate for Payer: University Health Alliance Commercial |
$10.20
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
NDC 45802006436
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicare |
$25.84
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Devoted Health Medicare |
$28.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.30
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Humana Medicare |
$25.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.84
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.84
|
| Rate for Payer: University Health Alliance Commercial |
$24.78
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 51672128201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$15.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$16.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$15.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.20
|
| Rate for Payer: University Health Alliance Commercial |
$14.58
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
NDC 67877025115
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.50 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: AlohaCare Medicaid |
$10.50
|
| Rate for Payer: AlohaCare Medicare |
$15.96
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Devoted Health Medicare |
$17.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.95
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Humana Medicare |
$15.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.96
|
| Rate for Payer: MDX Hawaii PPO |
$20.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.96
|
| Rate for Payer: University Health Alliance Commercial |
$15.31
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL CREAM [8113]
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
NDC 00168000415
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$9.88
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$10.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$9.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.88
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.88
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
NDC 51672128401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Health Management Network Commercial |
$17.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.90
|
| Rate for Payer: MDX Hawaii PPO |
$20.37
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
NDC 51672128408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$35.72
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$39.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.65
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$35.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.72
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.72
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
NDC 51672128408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
NDC 00168000680
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$47.53 |
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Health Management Network Commercial |
$41.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.10
|
| Rate for Payer: MDX Hawaii PPO |
$47.53
|
|
|
TRIAMCINOLONE ACETONIDE 0.1 % TOPICAL OINTMENT [8118]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 45802005535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
|
