|
DEXTROSE 50 % IN WATER (D50W) IV SYR
|
Facility
|
OP
|
$99.56
|
|
|
Service Code
|
NDC 00409751766
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$98.56 |
| Rate for Payer: AlohaCare Medicaid |
$49.78
|
| Rate for Payer: AlohaCare Medicare |
$89.60
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: Devoted Health Medicare |
$98.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.58
|
| Rate for Payer: Health Management Network Commercial |
$84.63
|
| Rate for Payer: Humana Medicare |
$89.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.60
|
| Rate for Payer: MDX Hawaii PPO |
$96.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.60
|
| Rate for Payer: University Health Alliance Commercial |
$72.57
|
|
|
DEXTROSE 50 % IN WATER (D50W) IV SYR
|
Facility
|
OP
|
$99.56
|
|
|
Service Code
|
NDC 00409751716
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.78 |
| Max. Negotiated Rate |
$98.56 |
| Rate for Payer: AlohaCare Medicaid |
$49.78
|
| Rate for Payer: AlohaCare Medicare |
$89.60
|
| Rate for Payer: Cash Price |
$64.71
|
| Rate for Payer: Devoted Health Medicare |
$98.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.58
|
| Rate for Payer: Health Management Network Commercial |
$84.63
|
| Rate for Payer: Humana Medicare |
$89.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.60
|
| Rate for Payer: MDX Hawaii PPO |
$96.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.60
|
| Rate for Payer: University Health Alliance Commercial |
$72.57
|
|
|
DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 1000 ML
|
Facility
|
IP
|
$22.08
|
|
|
Service Code
|
HCPCS J7070
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
|
|
DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 1000 ML
|
Facility
|
OP
|
$22.08
|
|
|
Service Code
|
HCPCS J7070
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: AlohaCare Medicaid |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Devoted Health Medicare |
$21.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.98
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Humana Medicare |
$19.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.87
|
| Rate for Payer: University Health Alliance Commercial |
$16.09
|
|
|
DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 500 ML
|
Facility
|
OP
|
$22.08
|
|
|
Service Code
|
HCPCS J7060
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.03 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: AlohaCare Medicaid |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Devoted Health Medicare |
$21.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.98
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Humana Medicare |
$19.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.87
|
| Rate for Payer: University Health Alliance Commercial |
$16.09
|
|
|
DEXTROSE 5% IN WATER (D5W) IV BASE SOLP 500 ML
|
Facility
|
IP
|
$22.08
|
|
|
Service Code
|
HCPCS J7060
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
OP
|
$20.70
|
|
|
Service Code
|
NDC 00264751020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.35 |
| Max. Negotiated Rate |
$20.49 |
| Rate for Payer: AlohaCare Medicaid |
$10.35
|
| Rate for Payer: AlohaCare Medicare |
$18.63
|
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Devoted Health Medicare |
$20.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.66
|
| Rate for Payer: Health Management Network Commercial |
$17.59
|
| Rate for Payer: Humana Medicare |
$18.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.63
|
| Rate for Payer: MDX Hawaii PPO |
$20.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.63
|
| Rate for Payer: University Health Alliance Commercial |
$15.09
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
OP
|
$22.08
|
|
|
Service Code
|
NDC 00264751000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: AlohaCare Medicaid |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Devoted Health Medicare |
$21.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.98
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Humana Medicare |
$19.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.87
|
| Rate for Payer: University Health Alliance Commercial |
$16.09
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
IP
|
$13.80
|
|
|
Service Code
|
NDC 00264151032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.73 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Cash Price |
$8.97
|
| Rate for Payer: Health Management Network Commercial |
$11.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.42
|
| Rate for Payer: MDX Hawaii PPO |
$13.39
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
IP
|
$22.08
|
|
|
Service Code
|
NDC 00264751010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
IP
|
$22.08
|
|
|
Service Code
|
NDC 00264751000
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$21.42 |
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
IP
|
$20.70
|
|
|
Service Code
|
NDC 00264751020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$20.08 |
| Rate for Payer: Cash Price |
$13.46
|
| Rate for Payer: Health Management Network Commercial |
$17.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.63
|
| Rate for Payer: MDX Hawaii PPO |
$20.08
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
IP
|
$13.53
|
|
|
Service Code
|
NDC 00264151031
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$13.12 |
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Health Management Network Commercial |
$11.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.18
|
| Rate for Payer: MDX Hawaii PPO |
$13.12
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
OP
|
$13.53
|
|
|
Service Code
|
NDC 00264151031
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$13.39 |
| Rate for Payer: Devoted Health Medicare |
$13.39
|
| Rate for Payer: AlohaCare Medicaid |
$6.76
|
| Rate for Payer: AlohaCare Medicare |
$12.18
|
| Rate for Payer: Cash Price |
$8.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.85
|
| Rate for Payer: Health Management Network Commercial |
$11.50
|
| Rate for Payer: Humana Medicare |
$12.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.18
|
| Rate for Payer: MDX Hawaii PPO |
$13.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.18
|
| Rate for Payer: University Health Alliance Commercial |
$9.86
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
OP
|
$22.08
|
|
|
Service Code
|
NDC 00264751010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$21.86 |
| Rate for Payer: AlohaCare Medicaid |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Devoted Health Medicare |
$21.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.98
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Humana Medicare |
$19.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.87
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.87
|
| Rate for Payer: University Health Alliance Commercial |
$16.09
|
|
|
DEXTROSE 5 % IN WATER (D5W) IV SOLP
|
Facility
|
OP
|
$13.80
|
|
|
Service Code
|
NDC 00264151032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$13.66 |
| Rate for Payer: AlohaCare Medicaid |
$6.90
|
| Rate for Payer: AlohaCare Medicare |
$12.42
|
| Rate for Payer: Cash Price |
$8.97
|
| 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 |
$13.11
|
| Rate for Payer: Health Management Network Commercial |
$11.73
|
| Rate for Payer: Humana Medicare |
$12.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.42
|
| Rate for Payer: MDX Hawaii PPO |
$13.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.42
|
| Rate for Payer: University Health Alliance Commercial |
$10.06
|
|
|
DEXTROSE 5 %-LACTATED RINGERS IV SOLP
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
HCPCS J7121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Health Management Network Commercial |
$14.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.90
|
| Rate for Payer: MDX Hawaii PPO |
$16.06
|
|
|
DEXTROSE 5 %-LACTATED RINGERS IV SOLP
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
HCPCS J7121
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: AlohaCare Medicaid |
$8.28
|
| Rate for Payer: AlohaCare Medicare |
$14.90
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Devoted Health Medicare |
$16.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.73
|
| Rate for Payer: Health Management Network Commercial |
$14.08
|
| Rate for Payer: Humana Medicare |
$14.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.90
|
| Rate for Payer: MDX Hawaii PPO |
$16.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.90
|
| Rate for Payer: University Health Alliance Commercial |
$12.07
|
|
|
DIABETES WITH CC
|
Facility
|
IP
|
$14,932.26
|
|
|
Service Code
|
MSDRG 638
|
| Min. Negotiated Rate |
$14,932.26 |
| Max. Negotiated Rate |
$14,932.26 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,932.26
|
|
|
DIABETES WITH MCC
|
Facility
|
IP
|
$15,074.47
|
|
|
Service Code
|
MSDRG 637
|
| Min. Negotiated Rate |
$15,074.47 |
| Max. Negotiated Rate |
$15,074.47 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,074.47
|
|
|
DIABETES WITHOUT CC/MCC
|
Facility
|
IP
|
$14,813.75
|
|
|
Service Code
|
MSDRG 639
|
| Min. Negotiated Rate |
$14,813.75 |
| Max. Negotiated Rate |
$14,813.75 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,813.75
|
|
|
DIAZEPAM 5 MG/ML INJ SYR
|
Facility
|
OP
|
$119.89
|
|
|
Service Code
|
HCPCS J3360
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$118.69 |
| Rate for Payer: AlohaCare Medicaid |
$59.95
|
| Rate for Payer: AlohaCare Medicare |
$107.90
|
| Rate for Payer: Cash Price |
$77.93
|
| Rate for Payer: Cash Price |
$77.93
|
| Rate for Payer: Devoted Health Medicare |
$118.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$107.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$113.90
|
| Rate for Payer: Health Management Network Commercial |
$101.91
|
| Rate for Payer: Humana Medicare |
$107.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$61.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$107.90
|
| Rate for Payer: MDX Hawaii PPO |
$116.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$107.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$107.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$107.90
|
| Rate for Payer: University Health Alliance Commercial |
$87.39
|
|
|
DIAZEPAM 5 MG/ML INJ SYR
|
Facility
|
IP
|
$119.89
|
|
|
Service Code
|
HCPCS J3360
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$101.91 |
| Max. Negotiated Rate |
$116.29 |
| Rate for Payer: Cash Price |
$77.93
|
| Rate for Payer: Health Management Network Commercial |
$101.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.90
|
| Rate for Payer: MDX Hawaii PPO |
$116.29
|
|
|
DIAZEPAM 5 MG PO TABLET
|
Facility
|
IP
|
$1.78
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$1.73 |
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Health Management Network Commercial |
$1.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.60
|
| Rate for Payer: MDX Hawaii PPO |
$1.73
|
|
|
DIAZEPAM 5 MG PO TABLET
|
Facility
|
OP
|
$1.78
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.76 |
| Rate for Payer: AlohaCare Medicaid |
$0.89
|
| Rate for Payer: AlohaCare Medicare |
$1.60
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Devoted Health Medicare |
$1.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.69
|
| Rate for Payer: Health Management Network Commercial |
$1.51
|
| Rate for Payer: Humana Medicare |
$1.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.60
|
| Rate for Payer: MDX Hawaii PPO |
$1.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.60
|
| Rate for Payer: University Health Alliance Commercial |
$1.30
|
|
