|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.58
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
2500498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Health Management Network Commercial |
$3.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.22
|
| Rate for Payer: MDX Hawaii PPO |
$3.47
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
NDC 69315090401
|
| Hospital Charge Code |
2500498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: AlohaCare Medicaid |
$1.79
|
| Rate for Payer: AlohaCare Medicare |
$1.79
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Devoted Health Medicare |
$1.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network Commercial |
$3.04
|
| Rate for Payer: Humana Medicare |
$1.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.79
|
| Rate for Payer: MDX Hawaii PPO |
$3.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.79
|
| Rate for Payer: University Health Alliance Commercial |
$2.61
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904600761
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687040101
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687040101
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687062701
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687062701
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084073601
|
| Hospital Charge Code |
2500498
|
|
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
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
IP
|
$3.68
|
|
|
Service Code
|
NDC 00591024005
|
| Hospital Charge Code |
2500498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.13 |
| Max. Negotiated Rate |
$3.57 |
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Health Management Network Commercial |
$3.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.31
|
| Rate for Payer: MDX Hawaii PPO |
$3.57
|
|
|
LORazepam 0.5 mg tablet [HHSC]
|
Facility
|
OP
|
$3.58
|
|
|
Service Code
|
NDC 00591024001
|
| Hospital Charge Code |
2500498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.47 |
| Rate for Payer: AlohaCare Medicaid |
$1.79
|
| Rate for Payer: AlohaCare Medicare |
$1.79
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Devoted Health Medicare |
$1.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network Commercial |
$3.04
|
| Rate for Payer: Humana Medicare |
$1.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.79
|
| Rate for Payer: MDX Hawaii PPO |
$3.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.79
|
| Rate for Payer: University Health Alliance Commercial |
$2.61
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084074201
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687035501
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687035501
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687063801
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
IP
|
$4.89
|
|
|
Service Code
|
NDC 00591024101
|
| Hospital Charge Code |
2500499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Health Management Network Commercial |
$4.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.40
|
| Rate for Payer: MDX Hawaii PPO |
$4.74
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
OP
|
$4.89
|
|
|
Service Code
|
NDC 00591024101
|
| Hospital Charge Code |
2500499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$4.74 |
| Rate for Payer: AlohaCare Medicaid |
$2.44
|
| Rate for Payer: AlohaCare Medicare |
$2.44
|
| Rate for Payer: Cash Price |
$3.18
|
| Rate for Payer: Devoted Health Medicare |
$2.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.65
|
| Rate for Payer: Health Management Network Commercial |
$4.16
|
| Rate for Payer: Humana Medicare |
$2.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.44
|
| Rate for Payer: MDX Hawaii PPO |
$4.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.44
|
| Rate for Payer: University Health Alliance Commercial |
$3.56
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
2500499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Health Management Network Commercial |
$3.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.19
|
| Rate for Payer: MDX Hawaii PPO |
$4.52
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 00904600861
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
OP
|
$4.66
|
|
|
Service Code
|
NDC 69315090501
|
| Hospital Charge Code |
2500499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: AlohaCare Medicaid |
$2.33
|
| Rate for Payer: AlohaCare Medicare |
$2.33
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Devoted Health Medicare |
$2.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.43
|
| Rate for Payer: Health Management Network Commercial |
$3.96
|
| Rate for Payer: Humana Medicare |
$2.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.33
|
| Rate for Payer: MDX Hawaii PPO |
$4.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.33
|
| Rate for Payer: University Health Alliance Commercial |
$3.40
|
|
|
LORazepam 1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084074201
|
| Hospital Charge Code |
2500499
|
|
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
|
|
|
LORazepam 2 mg/1ml vial [HHSC]
|
Facility
|
OP
|
$21.76
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2500501
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: AlohaCare Medicaid |
$10.88
|
| Rate for Payer: AlohaCare Medicaid |
$2.50
|
| Rate for Payer: AlohaCare Medicaid |
$6.34
|
| Rate for Payer: AlohaCare Medicare |
$2.50
|
| Rate for Payer: AlohaCare Medicare |
$6.34
|
| Rate for Payer: AlohaCare Medicare |
$10.88
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Devoted Health Medicare |
$2.75
|
| Rate for Payer: Devoted Health Medicare |
$11.97
|
| Rate for Payer: Devoted Health Medicare |
$6.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.67
|
| Rate for Payer: Health Management Network Commercial |
$10.78
|
| Rate for Payer: Health Management Network Commercial |
$18.50
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Humana Medicare |
$10.88
|
| Rate for Payer: Humana Medicare |
$6.34
|
| Rate for Payer: Humana Medicare |
$2.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.50
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
| Rate for Payer: MDX Hawaii PPO |
$12.30
|
| Rate for Payer: MDX Hawaii PPO |
$21.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.88
|
| Rate for Payer: University Health Alliance Commercial |
$3.64
|
| Rate for Payer: University Health Alliance Commercial |
$15.86
|
| Rate for Payer: University Health Alliance Commercial |
$9.24
|
|
|
LORazepam 2 mg/1ml vial [HHSC]
|
Facility
|
IP
|
$21.76
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2500501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Cash Price |
$14.14
|
| Rate for Payer: Cash Price |
$8.24
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Health Management Network Commercial |
$4.25
|
| Rate for Payer: Health Management Network Commercial |
$10.78
|
| Rate for Payer: Health Management Network Commercial |
$18.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.58
|
| Rate for Payer: MDX Hawaii PPO |
$21.11
|
| Rate for Payer: MDX Hawaii PPO |
$12.30
|
| Rate for Payer: MDX Hawaii PPO |
$4.85
|
|
