|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION [27390]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
MORPHINE 10 MG/ML INTRAVENOUS SOLUTION [27390]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$3.41
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.41
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.41
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.41
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
MORPHINE 10 MG RECTAL SUPPOSITORY [5180]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 00574711212
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$5.89
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$6.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$5.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.89
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.89
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
MORPHINE 10 MG RECTAL SUPPOSITORY [5180]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 00574711212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET [5178]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00054023524
|
|
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
|
|
|
MORPHINE 15 MG IMMEDIATE RELEASE TABLET [5178]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00054023524
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$1.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$1.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$1.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.24
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.24
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
MORPHINE 2 MG/ML INJECTION SYRINGE [5170]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
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
|
|
|
MORPHINE 2 MG/ML INJECTION SYRINGE [5170]
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
|
MORPHINE 2 MG/ML INJ SYRINGE/CARPUJECT (WRAPPED) [4080549]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
MORPHINE 2 MG/ML INJ SYRINGE/CARPUJECT (WRAPPED) [4080549]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
MORPHINE 2 MG/ML INTRAVENOUS SYRINGE [119146]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
MORPHINE 2 MG/ML INTRAVENOUS SYRINGE [119146]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE [5172]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
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
|
|
|
MORPHINE 4 MG/ML INJECTION SYRINGE [5172]
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
|
MORPHINE 4 MG/ML INJ SYRINGE/CARPUJECT (WRAPPED) [4080550]
|
Facility
|
IP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
|
|
MORPHINE 4 MG/ML INJ SYRINGE/CARPUJECT (WRAPPED) [4080550]
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$12.61 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
MORPHINE 4 MG/ML INTRAVENOUS SYRINGE [117338]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.79 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: AlohaCare Medicaid |
$4.50
|
| Rate for Payer: AlohaCare Medicare |
$2.79
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Devoted Health Medicare |
$3.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$4.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$4.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.55
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Humana Medicare |
$2.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.79
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.79
|
| Rate for Payer: University Health Alliance Commercial |
$6.56
|
|
|
MORPHINE 4 MG/ML INTRAVENOUS SYRINGE [117338]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$8.73 |
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Health Management Network Commercial |
$7.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.10
|
| Rate for Payer: MDX Hawaii PPO |
$8.73
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
NDC 00406800330
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.45 |
| Max. Negotiated Rate |
$55.29 |
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.30
|
| Rate for Payer: MDX Hawaii PPO |
$55.29
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
NDC 27808008201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.55 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
NDC 00406800330
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.67 |
| Max. Negotiated Rate |
$55.29 |
| Rate for Payer: AlohaCare Medicaid |
$28.50
|
| Rate for Payer: AlohaCare Medicare |
$17.67
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Devoted Health Medicare |
$19.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.15
|
| Rate for Payer: Health Management Network Commercial |
$48.45
|
| Rate for Payer: Humana Medicare |
$17.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.67
|
| Rate for Payer: MDX Hawaii PPO |
$55.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.67
|
| Rate for Payer: University Health Alliance Commercial |
$41.55
|
|
|
MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLUTION [10655]
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
NDC 27808008201
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$61.11 |
| Rate for Payer: AlohaCare Medicaid |
$31.50
|
| Rate for Payer: AlohaCare Medicare |
$19.53
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Devoted Health Medicare |
$21.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.85
|
| Rate for Payer: Health Management Network Commercial |
$53.55
|
| Rate for Payer: Humana Medicare |
$19.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.53
|
| Rate for Payer: MDX Hawaii PPO |
$61.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.53
|
| Rate for Payer: University Health Alliance Commercial |
$45.92
|
|
|
MORPHINE CONCENTRATE 20 MG/ML ORAL SOLN SYRINGE [4080141]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00004080109
|
|
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
|
|
|
MORPHINE CONCENTRATE 20 MG/ML ORAL SOLN SYRINGE [4080141]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00004080109
|
|
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
|
|
|
MORPHINE ER 100 MG TABLET,EXTENDED RELEASE [119248]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 42858080401
|
|
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
|
|
