|
warfarin 3 mg tablet [HHSC]
|
Facility
|
OP
|
$14.87
|
|
|
Service Code
|
NDC 00056018875
|
| Hospital Charge Code |
2500861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.43 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: AlohaCare Medicaid |
$7.43
|
| Rate for Payer: AlohaCare Medicare |
$7.43
|
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: Devoted Health Medicare |
$8.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.13
|
| Rate for Payer: Health Management Network Commercial |
$12.64
|
| Rate for Payer: Humana Medicare |
$7.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.43
|
| Rate for Payer: MDX Hawaii PPO |
$14.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.43
|
| Rate for Payer: University Health Alliance Commercial |
$10.84
|
|
|
warfarin 3 mg tablet [HHSC]
|
Facility
|
IP
|
$14.87
|
|
|
Service Code
|
NDC 00056018875
|
| Hospital Charge Code |
2500861
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: Cash Price |
$9.67
|
| Rate for Payer: Health Management Network Commercial |
$12.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.38
|
| Rate for Payer: MDX Hawaii PPO |
$14.42
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
OP
|
$14.91
|
|
|
Service Code
|
NDC 00056016875
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: AlohaCare Medicaid |
$7.46
|
| Rate for Payer: AlohaCare Medicare |
$7.46
|
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Devoted Health Medicare |
$8.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.16
|
| Rate for Payer: Health Management Network Commercial |
$12.67
|
| Rate for Payer: Humana Medicare |
$7.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.46
|
| Rate for Payer: MDX Hawaii PPO |
$14.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.46
|
| Rate for Payer: University Health Alliance Commercial |
$10.87
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
IP
|
$3.66
|
|
|
Service Code
|
NDC 65162076510
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Health Management Network Commercial |
$3.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.29
|
| Rate for Payer: MDX Hawaii PPO |
$3.55
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
OP
|
$3.66
|
|
|
Service Code
|
NDC 65162076510
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: AlohaCare Medicaid |
$1.83
|
| Rate for Payer: AlohaCare Medicare |
$1.83
|
| Rate for Payer: Cash Price |
$2.38
|
| Rate for Payer: Devoted Health Medicare |
$2.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.48
|
| Rate for Payer: Health Management Network Commercial |
$3.11
|
| Rate for Payer: Humana Medicare |
$1.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.83
|
| Rate for Payer: MDX Hawaii PPO |
$3.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.83
|
| Rate for Payer: University Health Alliance Commercial |
$2.67
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
NDC 00093171601
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Health Management Network Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.32
|
| Rate for Payer: MDX Hawaii PPO |
$3.58
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
OP
|
$3.67
|
|
|
Service Code
|
NDC 00832121501
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: AlohaCare Medicaid |
$1.83
|
| Rate for Payer: AlohaCare Medicare |
$1.83
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Devoted Health Medicare |
$2.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network Commercial |
$3.12
|
| Rate for Payer: Humana Medicare |
$1.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.83
|
| Rate for Payer: MDX Hawaii PPO |
$3.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.83
|
| Rate for Payer: University Health Alliance Commercial |
$2.68
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
IP
|
$3.67
|
|
|
Service Code
|
NDC 00832121501
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Management Network Commercial |
$3.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.30
|
| Rate for Payer: MDX Hawaii PPO |
$3.56
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
NDC 00093171601
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$3.58 |
| Rate for Payer: AlohaCare Medicaid |
$1.84
|
| Rate for Payer: AlohaCare Medicare |
$1.84
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Devoted Health Medicare |
$2.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.51
|
| Rate for Payer: Health Management Network Commercial |
$3.14
|
| Rate for Payer: Humana Medicare |
$1.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.84
|
| Rate for Payer: MDX Hawaii PPO |
$3.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.84
|
| Rate for Payer: University Health Alliance Commercial |
$2.69
|
|
|
warfarin 4 mg tablet [HHSC]
|
Facility
|
IP
|
$14.91
|
|
|
Service Code
|
NDC 00056016875
|
| Hospital Charge Code |
2500862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.67 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Cash Price |
$9.69
|
| Rate for Payer: Health Management Network Commercial |
$12.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.42
|
| Rate for Payer: MDX Hawaii PPO |
$14.46
|
|
|
warfarin 5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.82
|
|
|
Service Code
|
NDC 00832121601
|
| Hospital Charge Code |
2500863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: AlohaCare Medicaid |
$1.91
|
| Rate for Payer: AlohaCare Medicare |
$1.91
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Devoted Health Medicare |
$2.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.63
|
| Rate for Payer: Health Management Network Commercial |
$3.25
|
| Rate for Payer: Humana Medicare |
$1.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.91
|
| Rate for Payer: MDX Hawaii PPO |
$3.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.91
|
| Rate for Payer: University Health Alliance Commercial |
$2.78
|
|
|
warfarin 5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.75
|
|
|
Service Code
|
NDC 65162076610
|
| Hospital Charge Code |
2500863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Health Management Network Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.38
|
| Rate for Payer: MDX Hawaii PPO |
$3.64
|
|
|
warfarin 5 mg tablet [HHSC]
|
Facility
|
IP
|
$15.44
|
|
|
Service Code
|
NDC 00056017275
|
| Hospital Charge Code |
2500863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.12 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Health Management Network Commercial |
$13.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.90
|
| Rate for Payer: MDX Hawaii PPO |
$14.98
|
|
|
warfarin 5 mg tablet [HHSC]
|
Facility
|
OP
|
$15.44
|
|
|
Service Code
|
NDC 00056017275
|
| Hospital Charge Code |
2500863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$14.98 |
| Rate for Payer: AlohaCare Medicaid |
$7.72
|
| Rate for Payer: AlohaCare Medicare |
$7.72
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Devoted Health Medicare |
$8.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.67
|
| Rate for Payer: Health Management Network Commercial |
$13.12
|
| Rate for Payer: Humana Medicare |
$7.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.72
|
| Rate for Payer: MDX Hawaii PPO |
$14.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.72
|
| Rate for Payer: University Health Alliance Commercial |
$11.25
|
|
|
warfarin 5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.75
|
|
|
Service Code
|
NDC 65162076610
|
| Hospital Charge Code |
2500863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$3.64 |
| Rate for Payer: AlohaCare Medicaid |
$1.88
|
| Rate for Payer: AlohaCare Medicare |
$1.88
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Devoted Health Medicare |
$2.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.56
|
| Rate for Payer: Health Management Network Commercial |
$3.19
|
| Rate for Payer: Humana Medicare |
$1.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.88
|
| Rate for Payer: MDX Hawaii PPO |
$3.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.88
|
| Rate for Payer: University Health Alliance Commercial |
$2.73
|
|
|
warfarin 5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.82
|
|
|
Service Code
|
NDC 00832121601
|
| Hospital Charge Code |
2500863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.25 |
| Max. Negotiated Rate |
$3.71 |
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Health Management Network Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.44
|
| Rate for Payer: MDX Hawaii PPO |
$3.71
|
|
|
water for injection, sterile 100ml [HHSC]
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
2500791
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$21.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.36
|
| Rate for Payer: MDX Hawaii PPO |
$24.09
|
|
|
water for injection, sterile 100ml [HHSC]
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
HCPCS A4217
|
| Hospital Charge Code |
2500791
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.42 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: AlohaCare Medicaid |
$12.42
|
| Rate for Payer: AlohaCare Medicare |
$12.42
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Devoted Health Medicare |
$13.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.60
|
| Rate for Payer: Health Management Network Commercial |
$21.11
|
| Rate for Payer: Humana Medicare |
$12.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.42
|
| Rate for Payer: MDX Hawaii PPO |
$24.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.42
|
| Rate for Payer: University Health Alliance Commercial |
$18.11
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
OP
|
$5.82
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: AlohaCare Medicaid |
$2.91
|
| Rate for Payer: AlohaCare Medicare |
$2.91
|
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Devoted Health Medicare |
$3.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.53
|
| Rate for Payer: Health Management Network Commercial |
$4.95
|
| Rate for Payer: Humana Medicare |
$2.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$5.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.91
|
| Rate for Payer: University Health Alliance Commercial |
$4.24
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
IP
|
$23.29
|
|
|
Service Code
|
NDC 63323018510
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$22.59 |
| Rate for Payer: Cash Price |
$15.14
|
| Rate for Payer: Health Management Network Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.96
|
| Rate for Payer: MDX Hawaii PPO |
$22.59
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
IP
|
$5.82
|
|
|
Service Code
|
NDC 00409488710
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$5.65 |
| Rate for Payer: Cash Price |
$3.78
|
| Rate for Payer: Health Management Network Commercial |
$4.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.24
|
| Rate for Payer: MDX Hawaii PPO |
$5.65
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
IP
|
$20.82
|
|
|
Service Code
|
NDC 00641614710
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$20.20 |
| Rate for Payer: Cash Price |
$13.53
|
| Rate for Payer: Health Management Network Commercial |
$17.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.74
|
| Rate for Payer: MDX Hawaii PPO |
$20.20
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
IP
|
$40.13
|
|
|
Service Code
|
NDC 00641614725
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$38.93 |
| Rate for Payer: Cash Price |
$26.08
|
| Rate for Payer: Health Management Network Commercial |
$34.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.12
|
| Rate for Payer: MDX Hawaii PPO |
$38.93
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
OP
|
$40.13
|
|
|
Service Code
|
NDC 00641614725
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$38.93 |
| Rate for Payer: AlohaCare Medicaid |
$20.07
|
| Rate for Payer: AlohaCare Medicare |
$20.07
|
| Rate for Payer: Cash Price |
$26.08
|
| Rate for Payer: Devoted Health Medicare |
$22.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.12
|
| Rate for Payer: Health Management Network Commercial |
$34.11
|
| Rate for Payer: Humana Medicare |
$20.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.07
|
| Rate for Payer: MDX Hawaii PPO |
$38.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.07
|
| Rate for Payer: University Health Alliance Commercial |
$29.25
|
|
|
water for injection, sterile 10ml [HHSC]
|
Facility
|
OP
|
$7.62
|
|
|
Service Code
|
NDC 00409002410
|
| Hospital Charge Code |
2500793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.81 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: AlohaCare Medicaid |
$3.81
|
| Rate for Payer: AlohaCare Medicare |
$3.81
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Devoted Health Medicare |
$4.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.24
|
| Rate for Payer: Health Management Network Commercial |
$6.48
|
| Rate for Payer: Humana Medicare |
$3.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.81
|
| Rate for Payer: MDX Hawaii PPO |
$7.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.81
|
| Rate for Payer: University Health Alliance Commercial |
$5.55
|
|
