|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$9,599.31
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$9,599.31 |
| Max. Negotiated Rate |
$9,599.31 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9,599.31
|
|
|
Potassium (Arterial) POCT
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
9364700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: AlohaCare Medicaid |
$112.50
|
| Rate for Payer: AlohaCare Medicare |
$112.50
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Devoted Health Medicare |
$123.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$112.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.76
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Humana Medicare |
$112.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$114.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$112.50
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$112.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$112.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$112.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.88
|
|
|
Potassium (Arterial) POCT
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
HCPCS 84132
|
| Hospital Charge Code |
9364700
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$191.25 |
| Max. Negotiated Rate |
$218.25 |
| Rate for Payer: Cash Price |
$146.25
|
| Rate for Payer: Health Management Network Commercial |
$191.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$202.50
|
| Rate for Payer: MDX Hawaii PPO |
$218.25
|
|
|
potassium chlor 10 mEq/100 ml SWI [HHSC]
|
Facility
|
IP
|
$22.57
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
2500674
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.18 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$21.25
|
| Rate for Payer: Health Management Network Commercial |
$27.79
|
| Rate for Payer: Health Management Network Commercial |
$18.06
|
| Rate for Payer: Health Management Network Commercial |
$19.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.31
|
| Rate for Payer: MDX Hawaii PPO |
$21.89
|
| Rate for Payer: MDX Hawaii PPO |
$20.61
|
| Rate for Payer: MDX Hawaii PPO |
$31.71
|
|
|
potassium chlor 10 mEq/100 ml SWI [HHSC]
|
Facility
|
OP
|
$22.57
|
|
|
Service Code
|
HCPCS J3480
|
| Hospital Charge Code |
2500674
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$21.89 |
| Rate for Payer: AlohaCare Medicaid |
$11.29
|
| Rate for Payer: AlohaCare Medicaid |
$16.34
|
| Rate for Payer: AlohaCare Medicaid |
$10.62
|
| Rate for Payer: AlohaCare Medicare |
$16.34
|
| Rate for Payer: AlohaCare Medicare |
$10.62
|
| Rate for Payer: AlohaCare Medicare |
$11.29
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$21.25
|
| Rate for Payer: Cash Price |
$13.81
|
| Rate for Payer: Cash Price |
$21.25
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Cash Price |
$14.67
|
| Rate for Payer: Devoted Health Medicare |
$17.98
|
| Rate for Payer: Devoted Health Medicare |
$12.41
|
| Rate for Payer: Devoted Health Medicare |
$11.69
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.17
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.17
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.44
|
| Rate for Payer: Health Management Network Commercial |
$18.06
|
| Rate for Payer: Health Management Network Commercial |
$19.18
|
| Rate for Payer: Health Management Network Commercial |
$27.79
|
| Rate for Payer: Humana Medicare |
$11.29
|
| Rate for Payer: Humana Medicare |
$10.62
|
| Rate for Payer: Humana Medicare |
$16.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.34
|
| Rate for Payer: MDX Hawaii PPO |
$31.71
|
| Rate for Payer: MDX Hawaii PPO |
$20.61
|
| Rate for Payer: MDX Hawaii PPO |
$21.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.29
|
| Rate for Payer: University Health Alliance Commercial |
$23.83
|
| Rate for Payer: University Health Alliance Commercial |
$16.45
|
| Rate for Payer: University Health Alliance Commercial |
$15.49
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$61.98
|
|
|
Service Code
|
NDC 69238161703
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$59.37
|
|
|
Service Code
|
NDC 69238161708
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Health Management Network Commercial |
$50.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.43
|
| Rate for Payer: MDX Hawaii PPO |
$57.59
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$61.98
|
|
|
Service Code
|
NDC 00245036030
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: AlohaCare Medicaid |
$30.99
|
| Rate for Payer: AlohaCare Medicare |
$30.99
|
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Devoted Health Medicare |
$34.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.88
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Humana Medicare |
$30.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.99
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.99
|
| Rate for Payer: University Health Alliance Commercial |
$45.18
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$59.35
|
|
|
Service Code
|
NDC 54288012510
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: AlohaCare Medicaid |
$29.68
|
| Rate for Payer: AlohaCare Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Devoted Health Medicare |
$32.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.38
|
| Rate for Payer: Health Management Network Commercial |
$50.45
|
| Rate for Payer: Humana Medicare |
$29.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.68
|
| Rate for Payer: MDX Hawaii PPO |
$57.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.68
|
| Rate for Payer: University Health Alliance Commercial |
$43.26
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$59.37
|
|
|
Service Code
|
NDC 69238161708
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: AlohaCare Medicaid |
$29.68
|
| Rate for Payer: AlohaCare Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Devoted Health Medicare |
$32.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$50.46
|
| Rate for Payer: Humana Medicare |
$29.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.68
|
| Rate for Payer: MDX Hawaii PPO |
$57.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.68
|
| Rate for Payer: University Health Alliance Commercial |
$43.27
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$61.98
|
|
|
Service Code
|
NDC 69543045130
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$61.98
|
|
|
Service Code
|
NDC 69238161703
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: AlohaCare Medicaid |
$30.99
|
| Rate for Payer: AlohaCare Medicare |
$30.99
|
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Devoted Health Medicare |
$34.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.88
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Humana Medicare |
$30.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.99
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.99
|
| Rate for Payer: University Health Alliance Commercial |
$45.18
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$59.35
|
|
|
Service Code
|
NDC 54288012510
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.45 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Cash Price |
$38.58
|
| Rate for Payer: Health Management Network Commercial |
$50.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.41
|
| Rate for Payer: MDX Hawaii PPO |
$57.57
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$59.37
|
|
|
Service Code
|
NDC 60219161708
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.46 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Health Management Network Commercial |
$50.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.43
|
| Rate for Payer: MDX Hawaii PPO |
$57.59
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$59.37
|
|
|
Service Code
|
NDC 60219161708
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$57.59 |
| Rate for Payer: AlohaCare Medicaid |
$29.68
|
| Rate for Payer: AlohaCare Medicare |
$29.68
|
| Rate for Payer: Cash Price |
$38.59
|
| Rate for Payer: Devoted Health Medicare |
$32.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network Commercial |
$50.46
|
| Rate for Payer: Humana Medicare |
$29.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.68
|
| Rate for Payer: MDX Hawaii PPO |
$57.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.68
|
| Rate for Payer: University Health Alliance Commercial |
$43.27
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$61.98
|
|
|
Service Code
|
NDC 00245036030
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$61.98
|
|
|
Service Code
|
NDC 69543037930
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.68 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
IP
|
$8.67
|
|
|
Service Code
|
NDC 60687085592
|
| Hospital Charge Code |
2500678
|
|
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
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$8.67
|
|
|
Service Code
|
NDC 60687085592
|
| Hospital Charge Code |
2500678
|
|
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
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$61.98
|
|
|
Service Code
|
NDC 69543037930
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: AlohaCare Medicaid |
$30.99
|
| Rate for Payer: AlohaCare Medicare |
$30.99
|
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Devoted Health Medicare |
$34.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.88
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Humana Medicare |
$30.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.99
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.99
|
| Rate for Payer: University Health Alliance Commercial |
$45.18
|
|
|
potassium chlor 20 mEq packet [HHSC]
|
Facility
|
OP
|
$61.98
|
|
|
Service Code
|
NDC 69543045130
|
| Hospital Charge Code |
2500678
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$60.12 |
| Rate for Payer: AlohaCare Medicaid |
$30.99
|
| Rate for Payer: AlohaCare Medicare |
$30.99
|
| Rate for Payer: Cash Price |
$40.29
|
| Rate for Payer: Devoted Health Medicare |
$34.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.88
|
| Rate for Payer: Health Management Network Commercial |
$52.68
|
| Rate for Payer: Humana Medicare |
$30.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.99
|
| Rate for Payer: MDX Hawaii PPO |
$60.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.99
|
| Rate for Payer: University Health Alliance Commercial |
$45.18
|
|
|
potassium chlor ER 10 mEq tablet [HHSC]
|
Facility
|
OP
|
$3.40
|
|
|
Service Code
|
NDC 68084052401
|
| Hospital Charge Code |
2500673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.70 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: AlohaCare Medicaid |
$1.70
|
| Rate for Payer: AlohaCare Medicare |
$1.70
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Devoted Health Medicare |
$1.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.23
|
| Rate for Payer: Health Management Network Commercial |
$2.89
|
| Rate for Payer: Humana Medicare |
$1.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.70
|
| Rate for Payer: MDX Hawaii PPO |
$3.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.70
|
| Rate for Payer: University Health Alliance Commercial |
$2.48
|
|
|
potassium chlor ER 10 mEq tablet [HHSC]
|
Facility
|
IP
|
$3.40
|
|
|
Service Code
|
NDC 68084052401
|
| Hospital Charge Code |
2500673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$3.30 |
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Health Management Network Commercial |
$2.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.06
|
| Rate for Payer: MDX Hawaii PPO |
$3.30
|
|
|
potassium chlor ER 10 mEq tablet [HHSC]
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
2500673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Health Management Network Commercial |
$3.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.26
|
| Rate for Payer: MDX Hawaii PPO |
$3.51
|
|
|
potassium chlor ER 10 mEq tablet [HHSC]
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
NDC 00245531601
|
| Hospital Charge Code |
2500673
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$3.51 |
| Rate for Payer: AlohaCare Medicaid |
$1.81
|
| Rate for Payer: AlohaCare Medicare |
$1.81
|
| Rate for Payer: Cash Price |
$2.35
|
| Rate for Payer: Devoted Health Medicare |
$1.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.44
|
| Rate for Payer: Health Management Network Commercial |
$3.08
|
| Rate for Payer: Humana Medicare |
$1.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.81
|
| Rate for Payer: MDX Hawaii PPO |
$3.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.81
|
| Rate for Payer: University Health Alliance Commercial |
$2.64
|
|
