|
prazosin 1 mg capsule [HHSC]
|
Facility
|
IP
|
$5.30
|
|
|
Service Code
|
NDC 00093406701
|
| Hospital Charge Code |
2500688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$5.14 |
| Rate for Payer: Cash Price |
$3.44
|
| Rate for Payer: Health Management Network Commercial |
$4.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.77
|
| Rate for Payer: MDX Hawaii PPO |
$5.14
|
|
|
prazosin 1 mg capsule [HHSC]
|
Facility
|
IP
|
$4.98
|
|
|
Service Code
|
NDC 59651027101
|
| Hospital Charge Code |
2500688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$4.83 |
| Rate for Payer: Cash Price |
$3.24
|
| Rate for Payer: Health Management Network Commercial |
$4.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.48
|
| Rate for Payer: MDX Hawaii PPO |
$4.83
|
|
|
prazosin 1 mg capsule [HHSC]
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
NDC 68084099601
|
| Hospital Charge Code |
2500688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$9.62 |
| Rate for Payer: AlohaCare Medicaid |
$4.96
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Devoted Health Medicare |
$5.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.42
|
| Rate for Payer: Health Management Network Commercial |
$8.43
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: MDX Hawaii PPO |
$9.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: University Health Alliance Commercial |
$7.23
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
OP
|
$4.95
|
|
|
Service Code
|
NDC 70954002010
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: AlohaCare Medicaid |
$2.48
|
| Rate for Payer: AlohaCare Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Devoted Health Medicare |
$2.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.70
|
| Rate for Payer: Health Management Network Commercial |
$4.21
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.48
|
| Rate for Payer: MDX Hawaii PPO |
$4.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$3.61
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
OP
|
$7.08
|
|
|
Service Code
|
NDC 00093406801
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: AlohaCare Medicaid |
$3.54
|
| Rate for Payer: AlohaCare Medicare |
$3.54
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Devoted Health Medicare |
$3.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network Commercial |
$6.02
|
| Rate for Payer: Humana Medicare |
$3.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.54
|
| Rate for Payer: MDX Hawaii PPO |
$6.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.54
|
| Rate for Payer: University Health Alliance Commercial |
$5.16
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
IP
|
$4.95
|
|
|
Service Code
|
NDC 70954002010
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$4.80 |
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Health Management Network Commercial |
$4.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.46
|
| Rate for Payer: MDX Hawaii PPO |
$4.80
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
IP
|
$13.84
|
|
|
Service Code
|
NDC 68084099701
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Health Management Network Commercial |
$11.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.46
|
| Rate for Payer: MDX Hawaii PPO |
$13.42
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
IP
|
$7.35
|
|
|
Service Code
|
NDC 59651027201
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Health Management Network Commercial |
$6.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.62
|
| Rate for Payer: MDX Hawaii PPO |
$7.13
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
OP
|
$7.08
|
|
|
Service Code
|
NDC 66993043285
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: AlohaCare Medicaid |
$3.54
|
| Rate for Payer: AlohaCare Medicare |
$3.54
|
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Devoted Health Medicare |
$3.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.73
|
| Rate for Payer: Health Management Network Commercial |
$6.02
|
| Rate for Payer: Humana Medicare |
$3.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.54
|
| Rate for Payer: MDX Hawaii PPO |
$6.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.54
|
| Rate for Payer: University Health Alliance Commercial |
$5.16
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
OP
|
$7.35
|
|
|
Service Code
|
NDC 59651027201
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$7.13 |
| Rate for Payer: AlohaCare Medicaid |
$3.67
|
| Rate for Payer: AlohaCare Medicare |
$3.67
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Devoted Health Medicare |
$4.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network Commercial |
$6.25
|
| Rate for Payer: Humana Medicare |
$3.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.75
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.67
|
| Rate for Payer: MDX Hawaii PPO |
$7.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.67
|
| Rate for Payer: University Health Alliance Commercial |
$5.36
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
NDC 00093406801
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Health Management Network Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.37
|
| Rate for Payer: MDX Hawaii PPO |
$6.87
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
OP
|
$13.84
|
|
|
Service Code
|
NDC 68084099701
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$13.42 |
| Rate for Payer: AlohaCare Medicaid |
$6.92
|
| Rate for Payer: AlohaCare Medicare |
$6.92
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Devoted Health Medicare |
$7.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.15
|
| Rate for Payer: Health Management Network Commercial |
$11.76
|
| Rate for Payer: Humana Medicare |
$6.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.92
|
| Rate for Payer: MDX Hawaii PPO |
$13.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.92
|
| Rate for Payer: University Health Alliance Commercial |
$10.09
|
|
|
prazosin 2 mg capsule [HHSC]
|
Facility
|
IP
|
$7.08
|
|
|
Service Code
|
NDC 66993043285
|
| Hospital Charge Code |
2500689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.02 |
| Max. Negotiated Rate |
$6.87 |
| Rate for Payer: Cash Price |
$4.60
|
| Rate for Payer: Health Management Network Commercial |
$6.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.37
|
| Rate for Payer: MDX Hawaii PPO |
$6.87
|
|
|
Pre Albumin FSI
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
8118017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
Pre Albumin FSI
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 84134
|
| Hospital Charge Code |
8118017
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.59 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$83.00
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$91.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$20.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$21.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.59
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$83.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.00
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.00
|
| Rate for Payer: University Health Alliance Commercial |
$37.70
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC
|
Facility
|
IP
|
$20,407.42
|
|
|
Service Code
|
MSDRG 067
|
| Min. Negotiated Rate |
$20,407.42 |
| Max. Negotiated Rate |
$20,407.42 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,407.42
|
|
|
PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC
|
Facility
|
IP
|
$20,407.42
|
|
|
Service Code
|
MSDRG 068
|
| Min. Negotiated Rate |
$20,407.42 |
| Max. Negotiated Rate |
$20,407.42 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,407.42
|
|
|
prednisoLONE 15 mg/5 mL 5mL U/D [HHSC]
|
Facility
|
IP
|
$8.68
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
2500693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Health Management Network Commercial |
$7.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.81
|
| Rate for Payer: MDX Hawaii PPO |
$8.42
|
|
|
prednisoLONE 15 mg/5 mL 5mL U/D [HHSC]
|
Facility
|
OP
|
$8.68
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
2500693
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: AlohaCare Medicaid |
$4.34
|
| Rate for Payer: AlohaCare Medicare |
$4.34
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Devoted Health Medicare |
$4.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.25
|
| Rate for Payer: Health Management Network Commercial |
$7.38
|
| Rate for Payer: Humana Medicare |
$4.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.34
|
| Rate for Payer: MDX Hawaii PPO |
$8.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.34
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.34
|
| Rate for Payer: University Health Alliance Commercial |
$6.33
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
OP
|
$292.94
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$146.47 |
| Max. Negotiated Rate |
$284.15 |
| Rate for Payer: AlohaCare Medicaid |
$146.47
|
| Rate for Payer: AlohaCare Medicare |
$146.47
|
| Rate for Payer: Cash Price |
$190.41
|
| Rate for Payer: Devoted Health Medicare |
$161.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.29
|
| Rate for Payer: Health Management Network Commercial |
$249.00
|
| Rate for Payer: Humana Medicare |
$146.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$263.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.47
|
| Rate for Payer: MDX Hawaii PPO |
$284.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$175.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.47
|
| Rate for Payer: University Health Alliance Commercial |
$213.52
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
IP
|
$479.96
|
|
|
Service Code
|
NDC 00065063827
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$465.56 |
| Rate for Payer: Cash Price |
$311.97
|
| Rate for Payer: Health Management Network Commercial |
$407.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.96
|
| Rate for Payer: MDX Hawaii PPO |
$465.56
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
IP
|
$284.17
|
|
|
Service Code
|
NDC 60758011905
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$241.54 |
| Max. Negotiated Rate |
$275.64 |
| Rate for Payer: Cash Price |
$184.71
|
| Rate for Payer: Health Management Network Commercial |
$241.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$255.75
|
| Rate for Payer: MDX Hawaii PPO |
$275.64
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
IP
|
$292.94
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$249.00 |
| Max. Negotiated Rate |
$284.15 |
| Rate for Payer: Cash Price |
$190.41
|
| Rate for Payer: Health Management Network Commercial |
$249.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$263.65
|
| Rate for Payer: MDX Hawaii PPO |
$284.15
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
IP
|
$74.58
|
|
|
Service Code
|
NDC 58016655705
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.39 |
| Max. Negotiated Rate |
$72.34 |
| Rate for Payer: Cash Price |
$48.48
|
| Rate for Payer: Health Management Network Commercial |
$63.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.12
|
| Rate for Payer: MDX Hawaii PPO |
$72.34
|
|
|
prednisoLONE acetate 1% ophth drop [HHSC]
|
Facility
|
OP
|
$74.58
|
|
|
Service Code
|
NDC 58016655705
|
| Hospital Charge Code |
2500691
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.29 |
| Max. Negotiated Rate |
$72.34 |
| Rate for Payer: AlohaCare Medicaid |
$37.29
|
| Rate for Payer: AlohaCare Medicare |
$37.29
|
| Rate for Payer: Cash Price |
$48.48
|
| Rate for Payer: Devoted Health Medicare |
$41.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$70.85
|
| Rate for Payer: Health Management Network Commercial |
$63.39
|
| Rate for Payer: Humana Medicare |
$37.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.29
|
| Rate for Payer: MDX Hawaii PPO |
$72.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.29
|
| Rate for Payer: University Health Alliance Commercial |
$54.36
|
|
