|
metoprolol succ ER 25 mg tablet [HHSC]
|
Facility
|
IP
|
$6.20
|
|
|
Service Code
|
NDC 60687039001
|
| Hospital Charge Code |
2500541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Health Management Network Commercial |
$5.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$6.01
|
|
|
metoprolol succ ER 25 mg tablet [HHSC]
|
Facility
|
OP
|
$6.20
|
|
|
Service Code
|
NDC 60687039001
|
| 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
|
|
|
metoprolol succ ER 25 mg tablet [HHSC]
|
Facility
|
IP
|
$6.20
|
|
|
Service Code
|
NDC 68084065901
|
| Hospital Charge Code |
2500541
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Health Management Network Commercial |
$5.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$6.01
|
|
|
metoprolol succ ER 50 mg tablet [HHSC]
|
Facility
|
OP
|
$6.20
|
|
|
Service Code
|
NDC 60687040201
|
| Hospital Charge Code |
2500543
|
|
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
|
|
|
metoprolol succ ER 50 mg tablet [HHSC]
|
Facility
|
IP
|
$6.20
|
|
|
Service Code
|
NDC 68084066601
|
| Hospital Charge Code |
2500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Health Management Network Commercial |
$5.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$6.01
|
|
|
metoprolol succ ER 50 mg tablet [HHSC]
|
Facility
|
IP
|
$6.20
|
|
|
Service Code
|
NDC 60687040201
|
| Hospital Charge Code |
2500543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.27 |
| Max. Negotiated Rate |
$6.01 |
| Rate for Payer: Cash Price |
$4.03
|
| Rate for Payer: Health Management Network Commercial |
$5.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.58
|
| Rate for Payer: MDX Hawaii PPO |
$6.01
|
|
|
metoprolol succ ER 50 mg tablet [HHSC]
|
Facility
|
OP
|
$6.20
|
|
|
Service Code
|
NDC 68084066601
|
| Hospital Charge Code |
2500543
|
|
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
|
|
|
metoprolol tart 25 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 51079025520
|
| Hospital Charge Code |
2500542
|
|
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
|
|
|
metoprolol tart 25 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 57664050652
|
| Hospital Charge Code |
2500542
|
|
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 tart 25 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 51079025520
|
| Hospital Charge Code |
2500542
|
|
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 tart 25 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 57664050652
|
| Hospital Charge Code |
2500542
|
|
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
|
|
|
metoprolol tart 25 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
2500542
|
|
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
|
|
|
metoprolol tart 25 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 62584026501
|
| Hospital Charge Code |
2500542
|
|
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
|
|
|
metroNIDAZOLE 500 mg tablet [HHSC]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
NDC 68084096601
|
| Hospital Charge Code |
2500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Health Management Network Commercial |
$4.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.61
|
| Rate for Payer: MDX Hawaii PPO |
$4.97
|
|
|
metroNIDAZOLE 500 mg tablet [HHSC]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 68084096601
|
| Hospital Charge Code |
2500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: AlohaCare Medicaid |
$2.56
|
| Rate for Payer: AlohaCare Medicare |
$2.56
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Devoted Health Medicare |
$2.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.86
|
| Rate for Payer: Health Management Network Commercial |
$4.35
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.56
|
| Rate for Payer: MDX Hawaii PPO |
$4.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.56
|
| Rate for Payer: University Health Alliance Commercial |
$3.73
|
|
|
metroNIDAZOLE 500 mg tablet [HHSC]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
2500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Health Management Network Commercial |
$4.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.61
|
| Rate for Payer: MDX Hawaii PPO |
$4.97
|
|
|
metroNIDAZOLE 500 mg tablet [HHSC]
|
Facility
|
IP
|
$5.12
|
|
|
Service Code
|
NDC 60687042401
|
| Hospital Charge Code |
2500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Health Management Network Commercial |
$4.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.61
|
| Rate for Payer: MDX Hawaii PPO |
$4.97
|
|
|
metroNIDAZOLE 500 mg tablet [HHSC]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 60687055001
|
| Hospital Charge Code |
2500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: AlohaCare Medicaid |
$2.56
|
| Rate for Payer: AlohaCare Medicare |
$2.56
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Devoted Health Medicare |
$2.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.86
|
| Rate for Payer: Health Management Network Commercial |
$4.35
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.56
|
| Rate for Payer: MDX Hawaii PPO |
$4.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.56
|
| Rate for Payer: University Health Alliance Commercial |
$3.73
|
|
|
metroNIDAZOLE 500 mg tablet [HHSC]
|
Facility
|
OP
|
$5.12
|
|
|
Service Code
|
NDC 60687042401
|
| Hospital Charge Code |
2500546
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$4.97 |
| Rate for Payer: AlohaCare Medicaid |
$2.56
|
| Rate for Payer: AlohaCare Medicare |
$2.56
|
| Rate for Payer: Cash Price |
$3.33
|
| Rate for Payer: Devoted Health Medicare |
$2.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.86
|
| Rate for Payer: Health Management Network Commercial |
$4.35
|
| Rate for Payer: Humana Medicare |
$2.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.56
|
| Rate for Payer: MDX Hawaii PPO |
$4.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.56
|
| Rate for Payer: University Health Alliance Commercial |
$3.73
|
|
|
metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]
|
Facility
|
IP
|
$12.81
|
|
|
Service Code
|
NDC 00409015224
|
| Hospital Charge Code |
2500547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.89 |
| Max. Negotiated Rate |
$12.43 |
| Rate for Payer: Cash Price |
$8.33
|
| Rate for Payer: Health Management Network Commercial |
$10.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.53
|
| Rate for Payer: MDX Hawaii PPO |
$12.43
|
|
|
metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]
|
Facility
|
OP
|
$15.29
|
|
|
Service Code
|
NDC 25021013182
|
| Hospital Charge Code |
2500547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: AlohaCare Medicaid |
$7.64
|
| Rate for Payer: AlohaCare Medicare |
$7.64
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Devoted Health Medicare |
$8.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.53
|
| Rate for Payer: Health Management Network Commercial |
$13.00
|
| Rate for Payer: Humana Medicare |
$7.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.64
|
| Rate for Payer: MDX Hawaii PPO |
$14.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.64
|
| Rate for Payer: University Health Alliance Commercial |
$11.14
|
|
|
metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]
|
Facility
|
IP
|
$13.01
|
|
|
Service Code
|
NDC 00264553532
|
| Hospital Charge Code |
2500547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.06 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Health Management Network Commercial |
$11.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.71
|
| Rate for Payer: MDX Hawaii PPO |
$12.62
|
|
|
metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]
|
Facility
|
OP
|
$13.01
|
|
|
Service Code
|
NDC 00264553532
|
| Hospital Charge Code |
2500547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.50 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: AlohaCare Medicaid |
$6.50
|
| Rate for Payer: AlohaCare Medicare |
$6.50
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Devoted Health Medicare |
$7.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.36
|
| Rate for Payer: Health Management Network Commercial |
$11.06
|
| Rate for Payer: Humana Medicare |
$6.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.50
|
| Rate for Payer: MDX Hawaii PPO |
$12.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.50
|
| Rate for Payer: University Health Alliance Commercial |
$9.48
|
|
|
metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]
|
Facility
|
OP
|
$14.66
|
|
|
Service Code
|
NDC 00409781124
|
| Hospital Charge Code |
2500547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$14.22 |
| Rate for Payer: AlohaCare Medicaid |
$7.33
|
| Rate for Payer: AlohaCare Medicare |
$7.33
|
| Rate for Payer: Cash Price |
$9.53
|
| Rate for Payer: Devoted Health Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.93
|
| Rate for Payer: Health Management Network Commercial |
$12.46
|
| Rate for Payer: Humana Medicare |
$7.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.33
|
| Rate for Payer: MDX Hawaii PPO |
$14.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.33
|
| Rate for Payer: University Health Alliance Commercial |
$10.69
|
|
|
metroNIDAZOLE-ns 500 mg/100 ml premix [HHSC]
|
Facility
|
IP
|
$15.29
|
|
|
Service Code
|
NDC 25021013182
|
| Hospital Charge Code |
2500547
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$14.83 |
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Health Management Network Commercial |
$13.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.76
|
| Rate for Payer: MDX Hawaii PPO |
$14.83
|
|
