|
HUMERAL TRAY 40MM 110031402
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$790.50 |
| Max. Negotiated Rate |
$2,473.50 |
| Rate for Payer: AlohaCare Medicaid |
$1,275.00
|
| Rate for Payer: AlohaCare Medicare |
$790.50
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Devoted Health Medicare |
$867.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$790.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,785.00
|
| Rate for Payer: Health Management Network Commercial |
$2,167.50
|
| Rate for Payer: Humana Medicare |
$790.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,295.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,300.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$790.50
|
| Rate for Payer: MDX Hawaii PPO |
$2,473.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$790.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$790.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$790.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,428.00
|
|
|
HUMERAL TRAY 40MM 110031402
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,428.00 |
| Max. Negotiated Rate |
$2,473.50 |
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,785.00
|
| Rate for Payer: Health Management Network Commercial |
$2,167.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,295.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,473.50
|
| Rate for Payer: University Health Alliance Commercial |
$1,428.00
|
|
|
HUM INSERT 32X8MM 5571-S-3208
|
Facility
|
OP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.00 |
| Max. Negotiated Rate |
$3,104.00 |
| Rate for Payer: AlohaCare Medicaid |
$1,600.00
|
| Rate for Payer: AlohaCare Medicare |
$992.00
|
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Devoted Health Medicare |
$1,088.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$992.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,240.00
|
| Rate for Payer: Health Management Network Commercial |
$2,720.00
|
| Rate for Payer: Humana Medicare |
$992.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,880.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,632.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$992.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,104.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$992.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$992.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$992.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,792.00
|
|
|
HUM INSERT 32X8MM 5571-S-3208
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,792.00 |
| Max. Negotiated Rate |
$3,104.00 |
| Rate for Payer: Cash Price |
$1,920.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,240.00
|
| Rate for Payer: Health Management Network Commercial |
$2,720.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,880.00
|
| Rate for Payer: MDX Hawaii PPO |
$3,104.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,792.00
|
|
|
HUM PROTHROMBIN CPLX, 4-FACTOR 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [125430]
|
Facility
|
OP
|
$4,277.00
|
|
|
Service Code
|
HCPCS J7168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$4,148.69 |
| Rate for Payer: AlohaCare Medicaid |
$2,138.50
|
| Rate for Payer: AlohaCare Medicare |
$1,325.87
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Devoted Health Medicare |
$1,454.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,325.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,063.15
|
| Rate for Payer: Health Management Network Commercial |
$3,635.45
|
| Rate for Payer: Humana Medicare |
$1,325.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,849.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,181.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,325.87
|
| Rate for Payer: MDX Hawaii PPO |
$4,148.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,325.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,325.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,566.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,325.87
|
| Rate for Payer: University Health Alliance Commercial |
$3,117.51
|
|
|
HUM PROTHROMBIN CPLX, 4-FACTOR 1,000 UNIT (800-1,240 UNIT) IV SOLUTION [125430]
|
Facility
|
IP
|
$4,277.00
|
|
|
Service Code
|
HCPCS J7168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,635.45 |
| Max. Negotiated Rate |
$4,148.69 |
| Rate for Payer: Cash Price |
$2,566.20
|
| Rate for Payer: Health Management Network Commercial |
$3,635.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,849.30
|
| Rate for Payer: MDX Hawaii PPO |
$4,148.69
|
|
|
HUM STEM 12X128MM 5569-P-2012
|
Facility
|
OP
|
$9,010.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,793.10 |
| Max. Negotiated Rate |
$8,739.70 |
| Rate for Payer: AlohaCare Medicaid |
$4,505.00
|
| Rate for Payer: AlohaCare Medicare |
$2,793.10
|
| Rate for Payer: Cash Price |
$5,406.00
|
| Rate for Payer: Devoted Health Medicare |
$3,063.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,793.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,307.00
|
| Rate for Payer: Health Management Network Commercial |
$7,658.50
|
| Rate for Payer: Humana Medicare |
$2,793.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,109.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,595.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,793.10
|
| Rate for Payer: MDX Hawaii PPO |
$8,739.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,793.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,793.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,793.10
|
| Rate for Payer: University Health Alliance Commercial |
$5,045.60
|
|
|
HUM STEM 12X128MM 5569-P-2012
|
Facility
|
IP
|
$9,010.00
|
|
|
Service Code
|
HCPCS C1776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,045.60 |
| Max. Negotiated Rate |
$8,739.70 |
| Rate for Payer: Cash Price |
$5,406.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6,307.00
|
| Rate for Payer: Health Management Network Commercial |
$7,658.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,109.00
|
| Rate for Payer: MDX Hawaii PPO |
$8,739.70
|
| Rate for Payer: University Health Alliance Commercial |
$5,045.60
|
|
|
HYALURONATE SODIUM, STABILIZED 60 MG/3 ML INTRA-ARTICULAR SYRINGE [150807]
|
Facility
|
OP
|
$2,007.00
|
|
|
Service Code
|
HCPCS J7318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$1,946.79 |
| Rate for Payer: AlohaCare Medicaid |
$1,003.50
|
| Rate for Payer: AlohaCare Medicare |
$622.17
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Devoted Health Medicare |
$682.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.68
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$622.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,906.65
|
| Rate for Payer: Health Management Network Commercial |
$1,705.95
|
| Rate for Payer: Humana Medicare |
$622.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,806.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,023.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$622.17
|
| Rate for Payer: MDX Hawaii PPO |
$1,946.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$622.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$622.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,204.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$622.17
|
| Rate for Payer: University Health Alliance Commercial |
$1,462.90
|
|
|
HYALURONATE SODIUM, STABILIZED 60 MG/3 ML INTRA-ARTICULAR SYRINGE [150807]
|
Facility
|
IP
|
$2,007.00
|
|
|
Service Code
|
HCPCS J7318
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,705.95 |
| Max. Negotiated Rate |
$1,946.79 |
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Health Management Network Commercial |
$1,705.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,806.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,946.79
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
HCPCS J3473
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: AlohaCare Medicaid |
$67.00
|
| Rate for Payer: AlohaCare Medicare |
$41.54
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Devoted Health Medicare |
$45.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$127.30
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Humana Medicare |
$41.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$68.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$41.54
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$41.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$80.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.54
|
| Rate for Payer: University Health Alliance Commercial |
$97.67
|
|
|
HYALURONIDASE, HUMAN RECOMBINANT 150 UNIT/ML INJECTION SOLUTION [76338]
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
HCPCS J3473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.90 |
| Max. Negotiated Rate |
$129.98 |
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Health Management Network Commercial |
$113.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$120.60
|
| Rate for Payer: MDX Hawaii PPO |
$129.98
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687081111
|
|
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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 50111039801
|
|
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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 50111039801
|
|
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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687081101
|
|
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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687081111
|
|
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
|
|
|
HYDRALAZINE 10 MG TABLET [3698]
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 60687081101
|
|
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
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS J0360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$50.44 |
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Health Management Network Commercial |
$44.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.80
|
| Rate for Payer: MDX Hawaii PPO |
$50.44
|
|
|
HYDRALAZINE 20 MG/ML INJECTION SOLUTION [3697]
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS J0360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.19 |
| Max. Negotiated Rate |
$50.44 |
| Rate for Payer: AlohaCare Medicaid |
$26.00
|
| Rate for Payer: AlohaCare Medicare |
$16.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Devoted Health Medicare |
$17.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.12
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.40
|
| Rate for Payer: Health Management Network Commercial |
$44.20
|
| Rate for Payer: Humana Medicare |
$16.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.12
|
| Rate for Payer: MDX Hawaii PPO |
$50.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.12
|
| Rate for Payer: University Health Alliance Commercial |
$37.90
|
|
|
HYDRALAZINE 25 MG TABLET [3700]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687082211
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
HYDRALAZINE 25 MG TABLET [3700]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687082201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
HYDRALAZINE 25 MG TABLET [3700]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687082211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
HYDRALAZINE 25 MG TABLET [3700]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687082201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
HYDRALAZINE 50 MG TABLET [3701]
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 60687083301
|
|
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
|
|
