|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 00264580400
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
SODIUM CHLORIDE 0.45 % INTRAVENOUS SOLUTION [7318]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 00264580400
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$5.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.58
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 00264780200
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$5.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.58
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
NDC 00264780210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: AlohaCare Medicaid |
$8.00
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Devoted Health Medicare |
$5.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: University Health Alliance Commercial |
$11.66
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 00264580400
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 00264580400
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicare |
$5.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$5.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.58
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 00264780210
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
SODIUM CHLORIDE 0.45 % IV BOLUS [400292]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 00264780200
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
SODIUM CHLORIDE 0.65 % NASAL SPRAY AEROSOL [7030]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 00904386575
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 00409196607
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
|
|
SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
NDC 63323092410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
|
|
SODIUM CHLORIDE 0.9 %, BACTERIOSTATIC INJECTION SOLUTION [7028]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
NDC 00409196602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Health Management Network Commercial |
$8.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.70
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 00409488820
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 63323018620
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 00409488803
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00409488810
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
NDC 63323018603
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00409488802
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 63323018610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$4.85 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
|
SODIUM CHLORIDE 0.9 % INJECTION SOLUTION [168927]
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
NDC 63323018601
|
|
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
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicaid |
$7.00
|
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicare |
$0.93
|
| Rate for Payer: AlohaCare Medicare |
$0.31
|
| Rate for Payer: AlohaCare Medicare |
$4.34
|
| Rate for Payer: AlohaCare Medicare |
$1.86
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: AlohaCare Medicare |
$0.62
|
| Rate for Payer: AlohaCare Medicare |
$3.72
|
| Rate for Payer: AlohaCare Medicare |
$5.58
|
| Rate for Payer: AlohaCare Medicare |
$3.41
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Devoted Health Medicare |
$0.68
|
| Rate for Payer: Devoted Health Medicare |
$4.76
|
| Rate for Payer: Devoted Health Medicare |
$4.08
|
| Rate for Payer: Devoted Health Medicare |
$0.34
|
| Rate for Payer: Devoted Health Medicare |
$3.74
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Devoted Health Medicare |
$1.02
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.58
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.30
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Humana Medicare |
$3.72
|
| Rate for Payer: Humana Medicare |
$5.58
|
| Rate for Payer: Humana Medicare |
$0.93
|
| Rate for Payer: Humana Medicare |
$4.34
|
| Rate for Payer: Humana Medicare |
$1.86
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Humana Medicare |
$0.31
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.62
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.41
|
| Rate for Payer: University Health Alliance Commercial |
$10.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
| Rate for Payer: University Health Alliance Commercial |
$1.46
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
|
|
SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION [27838]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7030
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Health Management Network Commercial |
$1.70
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$1.94
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION [11403]
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
NDC 00264220110
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$15.52 |
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Health Management Network Commercial |
$13.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.40
|
| Rate for Payer: MDX Hawaii PPO |
$15.52
|
|
|
SODIUM CHLORIDE 0.9 % IRRIGATION SOLUTION [11403]
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 00264220100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
|
|
SODIUM CHLORIDE 0.9 % IV BOLUS [400291]
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J7050
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$17.46 |
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicaid |
$7.00
|
| Rate for Payer: AlohaCare Medicare |
$4.03
|
| Rate for Payer: AlohaCare Medicare |
$5.58
|
| Rate for Payer: AlohaCare Medicare |
$3.41
|
| Rate for Payer: AlohaCare Medicare |
$4.34
|
| Rate for Payer: AlohaCare Medicare |
$3.72
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Devoted Health Medicare |
$4.42
|
| Rate for Payer: Devoted Health Medicare |
$4.76
|
| Rate for Payer: Devoted Health Medicare |
$4.08
|
| Rate for Payer: Devoted Health Medicare |
$3.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network Commercial |
$11.05
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Health Management Network Commercial |
$10.20
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Humana Medicare |
$4.03
|
| Rate for Payer: Humana Medicare |
$5.58
|
| Rate for Payer: Humana Medicare |
$4.34
|
| Rate for Payer: Humana Medicare |
$3.72
|
| Rate for Payer: Humana Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.03
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
| Rate for Payer: MDX Hawaii PPO |
$12.61
|
| Rate for Payer: MDX Hawaii PPO |
$11.64
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.53
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.58
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
| Rate for Payer: University Health Alliance Commercial |
$10.20
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
