|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
NDC 68084041501
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: AlohaCare Medicaid |
$7.00
|
| Rate for Payer: AlohaCare Medicare |
$10.64
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Devoted Health Medicare |
$11.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.30
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Humana Medicare |
$10.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.64
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.64
|
| Rate for Payer: University Health Alliance Commercial |
$10.20
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
NDC 68084041501
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.90 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Health Management Network Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.60
|
| Rate for Payer: MDX Hawaii PPO |
$13.58
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 68084041502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 68084041502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
NDC 68084041593
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
|
|
DIVALPROEX ER 500 MG TABLET,EXTENDED RELEASE 24 HR [81426]
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
NDC 68084041593
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$10.67 |
| Rate for Payer: AlohaCare Medicaid |
$5.50
|
| Rate for Payer: AlohaCare Medicare |
$8.36
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Devoted Health Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.45
|
| Rate for Payer: Health Management Network Commercial |
$9.35
|
| Rate for Payer: Humana Medicare |
$8.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.36
|
| Rate for Payer: MDX Hawaii PPO |
$10.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.36
|
| Rate for Payer: University Health Alliance Commercial |
$8.02
|
|
|
D-M DRAINGAGE CATH 12FR
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS C1729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.00 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: AlohaCare Medicaid |
$184.00
|
| Rate for Payer: AlohaCare Medicare |
$279.68
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Devoted Health Medicare |
$309.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.68
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.60
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Humana Medicare |
$279.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.68
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.68
|
| Rate for Payer: University Health Alliance Commercial |
$268.24
|
|
|
D-M DRAINGAGE CATH 12FR
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS C1729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
|
|
DMUELLER DRAINAGE CATH 10.2F
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
HCPCS C1729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$346.29 |
| Rate for Payer: AlohaCare Medicaid |
$178.50
|
| Rate for Payer: AlohaCare Medicare |
$271.32
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Devoted Health Medicare |
$299.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$271.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$339.15
|
| Rate for Payer: Health Management Network Commercial |
$303.45
|
| Rate for Payer: Humana Medicare |
$271.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$271.32
|
| Rate for Payer: MDX Hawaii PPO |
$346.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$271.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$271.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$271.32
|
| Rate for Payer: University Health Alliance Commercial |
$260.22
|
|
|
DMUELLER DRAINAGE CATH 10.2F
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
HCPCS C1729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.45 |
| Max. Negotiated Rate |
$346.29 |
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Health Management Network Commercial |
$303.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.30
|
| Rate for Payer: MDX Hawaii PPO |
$346.29
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS J1250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.98 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: AlohaCare Medicaid |
$11.00
|
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicaid |
$16.00
|
| Rate for Payer: AlohaCare Medicare |
$24.32
|
| Rate for Payer: AlohaCare Medicare |
$16.72
|
| Rate for Payer: AlohaCare Medicare |
$25.08
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$18.48
|
| Rate for Payer: Devoted Health Medicare |
$27.72
|
| Rate for Payer: Devoted Health Medicare |
$26.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.98
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.35
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Humana Medicare |
$16.72
|
| Rate for Payer: Humana Medicare |
$24.32
|
| Rate for Payer: Humana Medicare |
$25.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.08
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.08
|
| Rate for Payer: University Health Alliance Commercial |
$16.04
|
| Rate for Payer: University Health Alliance Commercial |
$23.32
|
| Rate for Payer: University Health Alliance Commercial |
$24.05
|
|
|
DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) INTRAVENOUS SOLUTION [9892]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
HCPCS J1250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Health Management Network Commercial |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: MDX Hawaii PPO |
$31.04
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
DOBUTAMINE 250 MG/250 ML (1 MG/ML) IN 5 % DEXTROSE INTRAVENOUS [18314]
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
HCPCS J1250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$82.45 |
| Max. Negotiated Rate |
$94.09 |
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Health Management Network Commercial |
$82.45
|
| Rate for Payer: Health Management Network Commercial |
$83.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$87.30
|
| Rate for Payer: MDX Hawaii PPO |
$95.06
|
| Rate for Payer: MDX Hawaii PPO |
$94.09
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [116947]
|
Facility
|
IP
|
$1,044.00
|
|
|
Service Code
|
HCPCS J9171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$887.40 |
| Max. Negotiated Rate |
$1,012.68 |
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$2,629.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Health Management Network Commercial |
$2,067.20
|
| Rate for Payer: Health Management Network Commercial |
$887.40
|
| Rate for Payer: Health Management Network Commercial |
$3,724.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,188.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,943.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$939.60
|
| Rate for Payer: MDX Hawaii PPO |
$2,359.04
|
| Rate for Payer: MDX Hawaii PPO |
$1,012.68
|
| Rate for Payer: MDX Hawaii PPO |
$4,250.54
|
|
|
DOCETAXEL 160 MG/8 ML (20 MG/ML) INTRAVENOUS SOLUTION [116947]
|
Facility
|
OP
|
$1,044.00
|
|
|
Service Code
|
HCPCS J9171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1,012.68 |
| Rate for Payer: AlohaCare Medicaid |
$522.00
|
| Rate for Payer: AlohaCare Medicaid |
$2,191.00
|
| Rate for Payer: AlohaCare Medicaid |
$1,216.00
|
| Rate for Payer: AlohaCare Medicare |
$793.44
|
| Rate for Payer: AlohaCare Medicare |
$3,330.32
|
| Rate for Payer: AlohaCare Medicare |
$1,848.32
|
| Rate for Payer: Cash Price |
$2,629.20
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$626.40
|
| Rate for Payer: Cash Price |
$1,459.20
|
| Rate for Payer: Cash Price |
$2,629.20
|
| Rate for Payer: Devoted Health Medicare |
$876.96
|
| Rate for Payer: Devoted Health Medicare |
$3,680.88
|
| Rate for Payer: Devoted Health Medicare |
$2,042.88
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,848.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$793.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,330.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4,162.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$991.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,310.40
|
| Rate for Payer: Health Management Network Commercial |
$3,724.70
|
| Rate for Payer: Health Management Network Commercial |
$2,067.20
|
| Rate for Payer: Health Management Network Commercial |
$887.40
|
| Rate for Payer: Humana Medicare |
$1,848.32
|
| Rate for Payer: Humana Medicare |
$3,330.32
|
| Rate for Payer: Humana Medicare |
$793.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$939.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$2,188.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,943.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,234.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$532.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,240.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,330.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,848.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$793.44
|
| Rate for Payer: MDX Hawaii PPO |
$1,012.68
|
| Rate for Payer: MDX Hawaii PPO |
$4,250.54
|
| Rate for Payer: MDX Hawaii PPO |
$2,359.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$793.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,848.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,330.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$793.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,848.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,330.32
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,459.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$626.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2,629.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,848.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$793.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,330.32
|
| Rate for Payer: University Health Alliance Commercial |
$1,772.68
|
| Rate for Payer: University Health Alliance Commercial |
$3,194.04
|
| Rate for Payer: University Health Alliance Commercial |
$760.97
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS J9171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$191.09 |
| Rate for Payer: AlohaCare Medicaid |
$98.50
|
| Rate for Payer: AlohaCare Medicaid |
$184.00
|
| Rate for Payer: AlohaCare Medicare |
$279.68
|
| Rate for Payer: AlohaCare Medicare |
$149.72
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Devoted Health Medicare |
$165.48
|
| Rate for Payer: Devoted Health Medicare |
$309.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$279.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$149.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$187.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$349.60
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Humana Medicare |
$149.72
|
| Rate for Payer: Humana Medicare |
$279.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$187.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$100.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$149.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$279.68
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$279.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$149.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$149.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$279.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$220.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$118.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$149.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$279.68
|
| Rate for Payer: University Health Alliance Commercial |
$143.59
|
| Rate for Payer: University Health Alliance Commercial |
$268.24
|
|
|
DOCETAXEL 20 MG/ML (1 ML) INTRAVENOUS SOLUTION [106443]
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS J9171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.45 |
| Max. Negotiated Rate |
$191.09 |
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Health Management Network Commercial |
$167.45
|
| Rate for Payer: Health Management Network Commercial |
$312.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$177.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$331.20
|
| Rate for Payer: MDX Hawaii PPO |
$356.96
|
| Rate for Payer: MDX Hawaii PPO |
$191.09
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS J9171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$665.55 |
| Max. Negotiated Rate |
$759.51 |
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Health Management Network Commercial |
$665.55
|
| Rate for Payer: Health Management Network Commercial |
$569.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$603.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$704.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: MDX Hawaii PPO |
$649.90
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: MDX Hawaii PPO |
$759.51
|
|
|
DOCETAXEL 80 MG/4 ML (20 MG/ML) INTRAVENOUS SOLUTION [108122]
|
Facility
|
OP
|
$255.00
|
|
|
Service Code
|
HCPCS J9171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: AlohaCare Medicaid |
$127.50
|
| Rate for Payer: AlohaCare Medicaid |
$391.50
|
| Rate for Payer: AlohaCare Medicaid |
$335.00
|
| Rate for Payer: AlohaCare Medicare |
$509.20
|
| Rate for Payer: AlohaCare Medicare |
$193.80
|
| Rate for Payer: AlohaCare Medicare |
$595.08
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cash Price |
$402.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Devoted Health Medicare |
$214.20
|
| Rate for Payer: Devoted Health Medicare |
$657.72
|
| Rate for Payer: Devoted Health Medicare |
$562.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$193.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$595.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$509.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$636.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$242.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$743.85
|
| Rate for Payer: Health Management Network Commercial |
$665.55
|
| Rate for Payer: Health Management Network Commercial |
$216.75
|
| Rate for Payer: Health Management Network Commercial |
$569.50
|
| Rate for Payer: Humana Medicare |
$193.80
|
| Rate for Payer: Humana Medicare |
$509.20
|
| Rate for Payer: Humana Medicare |
$595.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$229.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$603.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$704.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$399.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$341.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$130.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$193.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$509.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$595.08
|
| Rate for Payer: MDX Hawaii PPO |
$759.51
|
| Rate for Payer: MDX Hawaii PPO |
$649.90
|
| Rate for Payer: MDX Hawaii PPO |
$247.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$509.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$193.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$595.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$509.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$193.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$595.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$402.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$153.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$469.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$509.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$193.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$595.08
|
| Rate for Payer: University Health Alliance Commercial |
$185.87
|
| Rate for Payer: University Health Alliance Commercial |
$488.36
|
| Rate for Payer: University Health Alliance Commercial |
$570.73
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2087]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687012911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2087]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904718361
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2087]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687012901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2087]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687012911
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2087]
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687012901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: AlohaCare Medicaid |
$0.50
|
| Rate for Payer: AlohaCare Medicare |
$0.76
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Devoted Health Medicare |
$0.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$0.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$0.95
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Humana Medicare |
$0.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$0.76
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$0.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$0.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$0.76
|
| Rate for Payer: University Health Alliance Commercial |
$0.73
|
|
|
DOCUSATE SODIUM 100 MG CAPSULE [2087]
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904718361
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$0.97 |
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Health Management Network Commercial |
$0.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$0.90
|
| Rate for Payer: MDX Hawaii PPO |
$0.97
|
|
