|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
IP
|
$10.45
|
|
|
Service Code
|
NDC 00121477405
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$10.14 |
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Health Management Network Commercial |
$8.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.40
|
| Rate for Payer: MDX Hawaii PPO |
$10.14
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
OP
|
$5.20
|
|
|
Service Code
|
NDC 68094060062
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: AlohaCare Medicaid |
$2.60
|
| Rate for Payer: AlohaCare Medicare |
$2.60
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Devoted Health Medicare |
$2.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.94
|
| Rate for Payer: Health Management Network Commercial |
$4.42
|
| Rate for Payer: Humana Medicare |
$2.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.60
|
| Rate for Payer: MDX Hawaii PPO |
$5.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.60
|
| Rate for Payer: University Health Alliance Commercial |
$3.79
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
OP
|
$4.87
|
|
|
Service Code
|
NDC 60687074317
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.72 |
| Rate for Payer: AlohaCare Medicaid |
$2.44
|
| Rate for Payer: AlohaCare Medicare |
$2.44
|
| Rate for Payer: Cash Price |
$3.17
|
| Rate for Payer: Devoted Health Medicare |
$2.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.63
|
| Rate for Payer: Health Management Network Commercial |
$4.14
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.44
|
| Rate for Payer: MDX Hawaii PPO |
$4.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.44
|
| Rate for Payer: University Health Alliance Commercial |
$3.55
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
OP
|
$3.34
|
|
|
Service Code
|
NDC 68094049462
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: AlohaCare Medicaid |
$1.67
|
| Rate for Payer: AlohaCare Medicare |
$1.67
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Devoted Health Medicare |
$1.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.17
|
| Rate for Payer: Health Management Network Commercial |
$2.84
|
| Rate for Payer: Humana Medicare |
$1.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.67
|
| Rate for Payer: MDX Hawaii PPO |
$3.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.67
|
| Rate for Payer: University Health Alliance Commercial |
$2.43
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
IP
|
$5.20
|
|
|
Service Code
|
NDC 68094060062
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$5.04 |
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Health Management Network Commercial |
$4.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.68
|
| Rate for Payer: MDX Hawaii PPO |
$5.04
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
IP
|
$3.34
|
|
|
Service Code
|
NDC 68094049462
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$3.24 |
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Health Management Network Commercial |
$2.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.01
|
| Rate for Payer: MDX Hawaii PPO |
$3.24
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
OP
|
$4.83
|
|
|
Service Code
|
NDC 00121091400
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: AlohaCare Medicaid |
$2.42
|
| Rate for Payer: AlohaCare Medicare |
$2.42
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Devoted Health Medicare |
$2.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.59
|
| Rate for Payer: Health Management Network Commercial |
$4.11
|
| Rate for Payer: Humana Medicare |
$2.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.42
|
| Rate for Payer: MDX Hawaii PPO |
$4.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.42
|
| Rate for Payer: University Health Alliance Commercial |
$3.52
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
OP
|
$10.45
|
|
|
Service Code
|
NDC 00121091840
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$10.14 |
| Rate for Payer: AlohaCare Medicaid |
$5.22
|
| Rate for Payer: AlohaCare Medicare |
$5.22
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Devoted Health Medicare |
$5.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.93
|
| Rate for Payer: Health Management Network Commercial |
$8.88
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.22
|
| Rate for Payer: MDX Hawaii PPO |
$10.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.22
|
| Rate for Payer: University Health Alliance Commercial |
$7.62
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
IP
|
$10.45
|
|
|
Service Code
|
NDC 00121091840
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$10.14 |
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Health Management Network Commercial |
$8.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.40
|
| Rate for Payer: MDX Hawaii PPO |
$10.14
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
OP
|
$4.85
|
|
|
Service Code
|
NDC 68094049461
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$4.70 |
| Rate for Payer: AlohaCare Medicaid |
$2.42
|
| Rate for Payer: AlohaCare Medicare |
$2.42
|
| Rate for Payer: Cash Price |
$3.15
|
| Rate for Payer: Devoted Health Medicare |
$2.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.61
|
| Rate for Payer: Health Management Network Commercial |
$4.12
|
| Rate for Payer: Humana Medicare |
$2.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.42
|
| Rate for Payer: MDX Hawaii PPO |
$4.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.42
|
| Rate for Payer: University Health Alliance Commercial |
$3.54
|
|
|
ibuprofen 100 mg/5 mL cup [HHSC]
|
Facility
|
IP
|
$4.83
|
|
|
Service Code
|
NDC 00121091400
|
| Hospital Charge Code |
2500407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Health Management Network Commercial |
$4.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.35
|
| Rate for Payer: MDX Hawaii PPO |
$4.69
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 63739067210
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 64380080906
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 64380080906
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084065801
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084065801
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687044601
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 67877031901
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904585361
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 63739067210
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 400 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687044601
|
| Hospital Charge Code |
2500409
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 600 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687045701
|
| Hospital Charge Code |
2500410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
ibuprofen 600 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 63739068410
|
| Hospital Charge Code |
2500410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| 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
|
|
