|
methylPRED sod succ 125 mg/ 2ml AOV [HHSC]
|
Facility
|
IP
|
$59.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
2500532
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.66 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cash Price |
$43.38
|
| Rate for Payer: Health Management Network Commercial |
$50.66
|
| Rate for Payer: Health Management Network Commercial |
$56.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.07
|
| Rate for Payer: MDX Hawaii PPO |
$64.74
|
| Rate for Payer: MDX Hawaii PPO |
$57.81
|
|
|
methylPRED sod succ 125 mg/ 2ml AOV [HHSC]
|
Facility
|
OP
|
$59.60
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
2500532
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$57.81 |
| Rate for Payer: AlohaCare Medicaid |
$29.80
|
| Rate for Payer: AlohaCare Medicaid |
$33.37
|
| Rate for Payer: AlohaCare Medicare |
$33.37
|
| Rate for Payer: AlohaCare Medicare |
$29.80
|
| Rate for Payer: Cash Price |
$43.38
|
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cash Price |
$38.74
|
| Rate for Payer: Cash Price |
$43.38
|
| Rate for Payer: Devoted Health Medicare |
$32.78
|
| Rate for Payer: Devoted Health Medicare |
$36.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.26
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.40
|
| Rate for Payer: Health Management Network Commercial |
$56.73
|
| Rate for Payer: Health Management Network Commercial |
$50.66
|
| Rate for Payer: Humana Medicare |
$29.80
|
| Rate for Payer: Humana Medicare |
$33.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.37
|
| Rate for Payer: MDX Hawaii PPO |
$57.81
|
| Rate for Payer: MDX Hawaii PPO |
$64.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.37
|
| Rate for Payer: University Health Alliance Commercial |
$43.44
|
| Rate for Payer: University Health Alliance Commercial |
$48.65
|
|
|
metoclopramide 10 mg/2 ml vial [HHSC]
|
Facility
|
OP
|
$22.37
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
2500537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: AlohaCare Medicaid |
$11.19
|
| Rate for Payer: AlohaCare Medicaid |
$4.01
|
| Rate for Payer: AlohaCare Medicare |
$4.01
|
| Rate for Payer: AlohaCare Medicare |
$11.19
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Devoted Health Medicare |
$12.30
|
| Rate for Payer: Devoted Health Medicare |
$4.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.62
|
| Rate for Payer: Health Management Network Commercial |
$6.82
|
| Rate for Payer: Health Management Network Commercial |
$19.01
|
| Rate for Payer: Humana Medicare |
$11.19
|
| Rate for Payer: Humana Medicare |
$4.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.01
|
| Rate for Payer: MDX Hawaii PPO |
$21.70
|
| Rate for Payer: MDX Hawaii PPO |
$7.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.01
|
| Rate for Payer: University Health Alliance Commercial |
$16.31
|
| Rate for Payer: University Health Alliance Commercial |
$5.85
|
|
|
metoclopramide 10 mg/2 ml vial [HHSC]
|
Facility
|
IP
|
$22.37
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
2500537
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.01 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Cash Price |
$5.21
|
| Rate for Payer: Health Management Network Commercial |
$19.01
|
| Rate for Payer: Health Management Network Commercial |
$6.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.22
|
| Rate for Payer: MDX Hawaii PPO |
$7.78
|
| Rate for Payer: MDX Hawaii PPO |
$21.70
|
|
|
metoclopramide 10 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 68084067601
|
| Hospital Charge Code |
2500535
|
|
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
|
|
|
metoclopramide 10 mg tablet [HHSC]
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
2500535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: Cash Price |
$2.60
|
| 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
|
|
|
metoclopramide 10 mg tablet [HHSC]
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
2500535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$3.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.00
|
| Rate for Payer: AlohaCare Medicare |
$2.00
|
| Rate for Payer: Cash Price |
$2.60
|
| Rate for Payer: Devoted Health Medicare |
$2.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.80
|
| Rate for Payer: Health Management Network Commercial |
$3.40
|
| Rate for Payer: Humana Medicare |
$2.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.00
|
| Rate for Payer: MDX Hawaii PPO |
$3.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.00
|
| Rate for Payer: University Health Alliance Commercial |
$2.92
|
|
|
metoclopramide 10 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 68084067601
|
| Hospital Charge Code |
2500535
|
|
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
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$7.01
|
|
|
Service Code
|
NDC 00409177805
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Health Management Network Commercial |
$5.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.31
|
| Rate for Payer: MDX Hawaii PPO |
$6.80
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$12.01
|
|
|
Service Code
|
NDC 70860030005
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: AlohaCare Medicaid |
$6.00
|
| Rate for Payer: AlohaCare Medicare |
$6.00
|
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Devoted Health Medicare |
$6.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.41
|
| Rate for Payer: Health Management Network Commercial |
$10.21
|
| Rate for Payer: Humana Medicare |
$6.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.00
|
| Rate for Payer: MDX Hawaii PPO |
$11.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.00
|
| Rate for Payer: University Health Alliance Commercial |
$8.75
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$12.01
|
|
|
Service Code
|
NDC 70860030005
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: Cash Price |
$7.81
|
| Rate for Payer: Health Management Network Commercial |
$10.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.81
|
| Rate for Payer: MDX Hawaii PPO |
$11.65
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$6.54
|
|
|
Service Code
|
NDC 47781058717
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: AlohaCare Medicaid |
$3.27
|
| Rate for Payer: AlohaCare Medicare |
$3.27
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Devoted Health Medicare |
$3.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network Commercial |
$5.56
|
| Rate for Payer: Humana Medicare |
$3.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.27
|
| Rate for Payer: MDX Hawaii PPO |
$6.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.27
|
| Rate for Payer: University Health Alliance Commercial |
$4.77
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$6.54
|
|
|
Service Code
|
NDC 47781058717
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Health Management Network Commercial |
$5.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.89
|
| Rate for Payer: MDX Hawaii PPO |
$6.34
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$6.54
|
|
|
Service Code
|
NDC 72611074010
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: AlohaCare Medicaid |
$3.27
|
| Rate for Payer: AlohaCare Medicare |
$3.27
|
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Devoted Health Medicare |
$3.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.21
|
| Rate for Payer: Health Management Network Commercial |
$5.56
|
| Rate for Payer: Humana Medicare |
$3.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.27
|
| Rate for Payer: MDX Hawaii PPO |
$6.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.27
|
| Rate for Payer: University Health Alliance Commercial |
$4.77
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$8.67
|
|
|
Service Code
|
NDC 72266012225
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Health Management Network Commercial |
$7.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.80
|
| Rate for Payer: MDX Hawaii PPO |
$8.41
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$8.67
|
|
|
Service Code
|
NDC 72266012225
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.33 |
| Max. Negotiated Rate |
$8.41 |
| Rate for Payer: AlohaCare Medicaid |
$4.33
|
| Rate for Payer: AlohaCare Medicare |
$4.33
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Devoted Health Medicare |
$4.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.24
|
| Rate for Payer: Health Management Network Commercial |
$7.37
|
| Rate for Payer: Humana Medicare |
$4.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.33
|
| Rate for Payer: MDX Hawaii PPO |
$8.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.33
|
| Rate for Payer: University Health Alliance Commercial |
$6.32
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$10.84
|
|
|
Service Code
|
NDC 36000003310
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.21 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Health Management Network Commercial |
$9.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.76
|
| Rate for Payer: MDX Hawaii PPO |
$10.51
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$10.84
|
|
|
Service Code
|
NDC 36000003310
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.42 |
| Max. Negotiated Rate |
$10.51 |
| Rate for Payer: AlohaCare Medicaid |
$5.42
|
| Rate for Payer: AlohaCare Medicare |
$5.42
|
| Rate for Payer: Cash Price |
$7.05
|
| Rate for Payer: Devoted Health Medicare |
$5.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.30
|
| Rate for Payer: Health Management Network Commercial |
$9.21
|
| Rate for Payer: Humana Medicare |
$5.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.42
|
| Rate for Payer: MDX Hawaii PPO |
$10.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.42
|
| Rate for Payer: University Health Alliance Commercial |
$7.90
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$7.01
|
|
|
Service Code
|
NDC 00409177805
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.50 |
| Max. Negotiated Rate |
$6.80 |
| Rate for Payer: AlohaCare Medicaid |
$3.50
|
| Rate for Payer: AlohaCare Medicare |
$3.50
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Devoted Health Medicare |
$3.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.66
|
| Rate for Payer: Health Management Network Commercial |
$5.96
|
| Rate for Payer: Humana Medicare |
$3.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.50
|
| Rate for Payer: MDX Hawaii PPO |
$6.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.50
|
| Rate for Payer: University Health Alliance Commercial |
$5.11
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$19.02
|
|
|
Service Code
|
NDC 25021030305
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.51 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: AlohaCare Medicaid |
$9.51
|
| Rate for Payer: AlohaCare Medicare |
$9.51
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Devoted Health Medicare |
$10.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.07
|
| Rate for Payer: Health Management Network Commercial |
$16.17
|
| Rate for Payer: Humana Medicare |
$9.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.51
|
| Rate for Payer: MDX Hawaii PPO |
$18.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.51
|
| Rate for Payer: University Health Alliance Commercial |
$13.86
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$6.54
|
|
|
Service Code
|
NDC 72611074010
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$6.34 |
| Rate for Payer: Cash Price |
$4.25
|
| Rate for Payer: Health Management Network Commercial |
$5.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.89
|
| Rate for Payer: MDX Hawaii PPO |
$6.34
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$7.11
|
|
|
Service Code
|
NDC 00409201610
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Health Management Network Commercial |
$6.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.40
|
| Rate for Payer: MDX Hawaii PPO |
$6.90
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
OP
|
$7.11
|
|
|
Service Code
|
NDC 00409201610
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$6.90 |
| Rate for Payer: AlohaCare Medicaid |
$3.56
|
| Rate for Payer: AlohaCare Medicare |
$3.56
|
| Rate for Payer: Cash Price |
$4.62
|
| Rate for Payer: Devoted Health Medicare |
$3.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.75
|
| Rate for Payer: Health Management Network Commercial |
$6.04
|
| Rate for Payer: Humana Medicare |
$3.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.56
|
| Rate for Payer: MDX Hawaii PPO |
$6.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.56
|
| Rate for Payer: University Health Alliance Commercial |
$5.18
|
|
|
metoprolol 5 mg/5 ml vial [HHSC]
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
NDC 25021030305
|
| Hospital Charge Code |
2500540
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Health Management Network Commercial |
$16.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.12
|
| Rate for Payer: MDX Hawaii PPO |
$18.45
|
|
|
metoprolol succ ER 25 mg tablet [HHSC]
|
Facility
|
OP
|
$6.20
|
|
|
Service Code
|
NDC 68084065901
|
| Hospital Charge Code |
2500541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.10 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: AlohaCare Medicaid |
$3.10
|
| Rate for Payer: AlohaCare Medicare |
$3.10
|
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Devoted Health Medicare |
$3.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.89
|
| Rate for Payer: Health Management Network Commercial |
$5.27
|
| Rate for Payer: Humana Medicare |
$3.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.10
|
| Rate for Payer: MDX Hawaii PPO |
$6.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.10
|
| Rate for Payer: University Health Alliance Commercial |
$4.52
|
|
