|
PUTTY BONE DBX 5CC
|
Facility
|
IP
|
$2,738.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.28 |
| Max. Negotiated Rate |
$2,655.86 |
| Rate for Payer: Cash Price |
$1,642.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,916.60
|
| Rate for Payer: Health Management Network Commercial |
$2,327.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,464.20
|
| Rate for Payer: MDX Hawaii PPO |
$2,655.86
|
| Rate for Payer: University Health Alliance Commercial |
$1,533.28
|
|
|
PUTTY BONE DBX 5CC
|
Facility
|
OP
|
$2,738.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.78 |
| Max. Negotiated Rate |
$2,655.86 |
| Rate for Payer: AlohaCare Medicaid |
$1,369.00
|
| Rate for Payer: AlohaCare Medicare |
$848.78
|
| Rate for Payer: Cash Price |
$1,642.80
|
| Rate for Payer: Devoted Health Medicare |
$930.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$848.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,916.60
|
| Rate for Payer: Health Management Network Commercial |
$2,327.30
|
| Rate for Payer: Humana Medicare |
$848.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,464.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,396.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$848.78
|
| Rate for Payer: MDX Hawaii PPO |
$2,655.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$848.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$848.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$848.78
|
| Rate for Payer: University Health Alliance Commercial |
$1,533.28
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 70954048420
|
|
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
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 70954048420
|
|
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
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 70954048410
|
|
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
|
|
|
PYRAZINAMIDE 500 MG TABLET [6738]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 70954048410
|
|
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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084049401
|
|
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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084049401
|
|
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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
NDC 68084049411
|
|
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
|
|
|
PYRIDOSTIGMINE BROMIDE 60 MG TABLET [11239]
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
NDC 68084049411
|
|
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
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
HCPCS J3415
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$56.10 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.40
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
|
|
PYRIDOXINE (VITAMIN B6) 100 MG/ML INJECTION SOLUTION [6744]
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
HCPCS J3415
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$64.02 |
| Rate for Payer: AlohaCare Medicaid |
$33.00
|
| Rate for Payer: AlohaCare Medicare |
$20.46
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Devoted Health Medicare |
$22.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$12.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.70
|
| Rate for Payer: Health Management Network Commercial |
$56.10
|
| Rate for Payer: Humana Medicare |
$20.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.46
|
| Rate for Payer: MDX Hawaii PPO |
$64.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.46
|
| Rate for Payer: University Health Alliance Commercial |
$48.11
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 85811000000
|
|
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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 70012000000
|
|
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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 85815000000
|
|
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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 70012000000
|
|
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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 85811000000
|
|
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
|
|
|
PYRIDOXINE (VITAMIN B6) 50 MG TABLET [6748]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 85815000000
|
|
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
|
|
|
QUADRASPHERE 20-40uM
|
Facility
|
OP
|
$2,340.00
|
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$2,269.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,170.00
|
| Rate for Payer: AlohaCare Medicare |
$725.40
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Devoted Health Medicare |
$795.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$725.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network Commercial |
$1,989.00
|
| Rate for Payer: Humana Medicare |
$725.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,193.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,269.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,404.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,705.63
|
|
|
QUADRASPHERE 20-40uM
|
Facility
|
IP
|
$2,340.00
|
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,269.80 |
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Health Management Network Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,106.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,269.80
|
|
|
QUADRASPHERE MICRO 50-100
|
Facility
|
OP
|
$2,340.00
|
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$725.40 |
| Max. Negotiated Rate |
$2,269.80 |
| Rate for Payer: AlohaCare Medicaid |
$1,170.00
|
| Rate for Payer: AlohaCare Medicare |
$725.40
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Devoted Health Medicare |
$795.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$725.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,223.00
|
| Rate for Payer: Health Management Network Commercial |
$1,989.00
|
| Rate for Payer: Humana Medicare |
$725.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,106.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,193.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$725.40
|
| Rate for Payer: MDX Hawaii PPO |
$2,269.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$725.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$725.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,404.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$725.40
|
| Rate for Payer: University Health Alliance Commercial |
$1,705.63
|
|
|
QUADRASPHERE MICRO 50-100
|
Facility
|
IP
|
$2,340.00
|
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,269.80 |
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Health Management Network Commercial |
$1,989.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,106.00
|
| Rate for Payer: MDX Hawaii PPO |
$2,269.80
|
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
NDC 60687034901
|
|
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
|
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 60687034901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$6.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$6.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$6.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.20
|
| Rate for Payer: University Health Alliance Commercial |
$14.58
|
|
|
QUETIAPINE 100 MG TABLET [21824]
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
NDC 60687034911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$19.40 |
| Rate for Payer: AlohaCare Medicaid |
$10.00
|
| Rate for Payer: AlohaCare Medicare |
$6.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Devoted Health Medicare |
$6.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.00
|
| Rate for Payer: Health Management Network Commercial |
$17.00
|
| Rate for Payer: Humana Medicare |
$6.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.20
|
| Rate for Payer: MDX Hawaii PPO |
$19.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.20
|
| Rate for Payer: University Health Alliance Commercial |
$14.58
|
|
