|
DICYCLOMINE 10 MG/5 ML ORAL SYRINGE [4080572]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 00004080073
|
|
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
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687036911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687036901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687036901
|
|
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
|
|
|
DICYCLOMINE 10 MG CAPSULE [2418]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687036911
|
|
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
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
HCPCS J0500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.70 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.60
|
| Rate for Payer: MDX Hawaii PPO |
$71.78
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
|
|
DICYCLOMINE 10 MG/ML INTRAMUSCULAR SOLUTION [2417]
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
HCPCS J0500
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$118.34 |
| Rate for Payer: AlohaCare Medicaid |
$61.00
|
| Rate for Payer: AlohaCare Medicaid |
$37.00
|
| Rate for Payer: AlohaCare Medicare |
$22.94
|
| Rate for Payer: AlohaCare Medicare |
$37.82
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Devoted Health Medicare |
$41.48
|
| Rate for Payer: Devoted Health Medicare |
$25.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$115.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.30
|
| Rate for Payer: Health Management Network Commercial |
$62.90
|
| Rate for Payer: Health Management Network Commercial |
$103.70
|
| Rate for Payer: Humana Medicare |
$37.82
|
| Rate for Payer: Humana Medicare |
$22.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$109.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$62.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.94
|
| Rate for Payer: MDX Hawaii PPO |
$118.34
|
| Rate for Payer: MDX Hawaii PPO |
$71.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$73.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.94
|
| Rate for Payer: University Health Alliance Commercial |
$88.93
|
| Rate for Payer: University Health Alliance Commercial |
$53.94
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687038011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687038001
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.94 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687038001
|
|
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
|
|
|
DICYCLOMINE 20 MG TABLET [2420]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687038011
|
|
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
|
|
|
DICYCLOMINE TABLETS (BENTYL) 20 MG (TAKE HOME) [4080354]
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
NDC 00004080142
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$12.75 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
|
|
DICYCLOMINE TABLETS (BENTYL) 20 MG (TAKE HOME) [4080354]
|
Facility
|
OP
|
$15.00
|
|
|
Service Code
|
NDC 00004080142
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$4.65 |
| Max. Negotiated Rate |
$14.55 |
| Rate for Payer: AlohaCare Medicaid |
$7.50
|
| Rate for Payer: AlohaCare Medicare |
$4.65
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$5.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.25
|
| Rate for Payer: Health Management Network Commercial |
$12.75
|
| Rate for Payer: Humana Medicare |
$4.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.65
|
| Rate for Payer: MDX Hawaii PPO |
$14.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.65
|
| Rate for Payer: University Health Alliance Commercial |
$10.93
|
|
|
DIGESTIVE MALIGNANCY WITH CC
|
Facility
|
IP
|
$54,633.11
|
|
|
Service Code
|
MSDRG 375
|
| Min. Negotiated Rate |
$54,633.11 |
| Max. Negotiated Rate |
$54,633.11 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$54,633.11
|
|
|
DIGESTIVE MALIGNANCY WITH MCC
|
Facility
|
IP
|
$55,936.72
|
|
|
Service Code
|
MSDRG 374
|
| Min. Negotiated Rate |
$55,936.72 |
| Max. Negotiated Rate |
$55,936.72 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$55,936.72
|
|
|
DIGESTIVE MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$28,489.80
|
|
|
Service Code
|
MSDRG 376
|
| Min. Negotiated Rate |
$28,489.80 |
| Max. Negotiated Rate |
$28,489.80 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28,489.80
|
|
|
DIGIT WIDGET EXTL FIX DWD-232
|
Facility
|
OP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,201.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,650.00
|
| Rate for Payer: AlohaCare Medicare |
$1,023.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Devoted Health Medicare |
$1,122.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,023.00
|
| 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 |
$1,023.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,970.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,683.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,023.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,201.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,023.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,023.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,023.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,848.00
|
|
|
DIGIT WIDGET EXTL FIX DWD-232
|
Facility
|
IP
|
$3,300.00
|
|
|
Service Code
|
HCPCS C1713
|
|
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
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 60687085811
|
|
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
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 60687085801
|
|
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
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60687054011
|
|
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
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 60687085811
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 60687085801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$5.82 |
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 60687054001
|
|
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
|
|
|
DIGOXIN 125 MCG (0.125 MG) TABLET [2444]
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
NDC 60687054011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.55 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$1.55
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$1.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$1.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.55
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.55
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
|
