|
RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE [168909]
|
Facility
|
IP
|
$2,049.00
|
|
|
Service Code
|
HCPCS J2801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,741.65 |
| Max. Negotiated Rate |
$1,987.53 |
| Rate for Payer: Cash Price |
$1,229.40
|
| Rate for Payer: Health Management Network Commercial |
$1,741.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,844.10
|
| Rate for Payer: MDX Hawaii PPO |
$1,987.53
|
|
|
RISPERIDONE MICROSPHERES ER 50 MG/2 ML INTRAMUSCULAR SUSP,EXT RELEASE [168909]
|
Facility
|
OP
|
$2,049.00
|
|
|
Service Code
|
HCPCS J2801
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.29 |
| Max. Negotiated Rate |
$1,987.53 |
| Rate for Payer: AlohaCare Medicaid |
$1,024.50
|
| Rate for Payer: AlohaCare Medicare |
$635.19
|
| Rate for Payer: Cash Price |
$1,229.40
|
| Rate for Payer: Cash Price |
$1,229.40
|
| Rate for Payer: Devoted Health Medicare |
$696.66
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$635.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,946.55
|
| Rate for Payer: Health Management Network Commercial |
$1,741.65
|
| Rate for Payer: Humana Medicare |
$635.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,844.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,044.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$635.19
|
| Rate for Payer: MDX Hawaii PPO |
$1,987.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$635.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$635.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,229.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$635.19
|
| Rate for Payer: University Health Alliance Commercial |
$1,493.52
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [129647]
|
Facility
|
OP
|
$1,692.00
|
|
|
Service Code
|
HCPCS J9312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.93 |
| Max. Negotiated Rate |
$1,641.24 |
| Rate for Payer: AlohaCare Medicaid |
$846.00
|
| Rate for Payer: AlohaCare Medicaid |
$4,228.00
|
| Rate for Payer: AlohaCare Medicare |
$524.52
|
| Rate for Payer: AlohaCare Medicare |
$2,621.36
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Cash Price |
$5,073.60
|
| Rate for Payer: Cash Price |
$5,073.60
|
| Rate for Payer: Devoted Health Medicare |
$575.28
|
| Rate for Payer: Devoted Health Medicare |
$2,875.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.93
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$75.93
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$92.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$524.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,621.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.93
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$75.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,607.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,033.20
|
| Rate for Payer: Health Management Network Commercial |
$1,438.20
|
| Rate for Payer: Health Management Network Commercial |
$7,187.60
|
| Rate for Payer: Humana Medicare |
$524.52
|
| Rate for Payer: Humana Medicare |
$2,621.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,610.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,522.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,312.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$862.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,621.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$524.52
|
| Rate for Payer: MDX Hawaii PPO |
$8,202.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,641.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,621.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$524.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$524.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,621.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,073.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,015.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$524.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,621.36
|
| Rate for Payer: University Health Alliance Commercial |
$6,163.58
|
| Rate for Payer: University Health Alliance Commercial |
$1,233.30
|
|
|
RITUXIMAB 10 MG/ML CONCENTRATE,INTRAVENOUS [129647]
|
Facility
|
IP
|
$8,456.00
|
|
|
Service Code
|
HCPCS J9312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,187.60 |
| Max. Negotiated Rate |
$8,202.32 |
| Rate for Payer: Cash Price |
$5,073.60
|
| Rate for Payer: Cash Price |
$1,015.20
|
| Rate for Payer: Health Management Network Commercial |
$7,187.60
|
| Rate for Payer: Health Management Network Commercial |
$1,438.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,522.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,610.40
|
| Rate for Payer: MDX Hawaii PPO |
$8,202.32
|
| Rate for Payer: MDX Hawaii PPO |
$1,641.24
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139634]
|
Facility
|
IP
|
$11,838.00
|
|
|
Service Code
|
HCPCS J9311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10,062.30 |
| Max. Negotiated Rate |
$11,482.86 |
| Rate for Payer: Cash Price |
$7,102.80
|
| Rate for Payer: Health Management Network Commercial |
$10,062.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,654.20
|
| Rate for Payer: MDX Hawaii PPO |
$11,482.86
|
|
|
RITUXIMAB 1,400 MG/11.7 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139634]
|
Facility
|
OP
|
$11,838.00
|
|
|
Service Code
|
HCPCS J9311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$11,482.86 |
| Rate for Payer: AlohaCare Medicaid |
$5,919.00
|
| Rate for Payer: AlohaCare Medicare |
$3,669.78
|
| Rate for Payer: Cash Price |
$7,102.80
|
| Rate for Payer: Cash Price |
$7,102.80
|
| Rate for Payer: Devoted Health Medicare |
$4,024.92
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3,669.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11,246.10
|
| Rate for Payer: Health Management Network Commercial |
$10,062.30
|
| Rate for Payer: Humana Medicare |
$3,669.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$10,654.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,037.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$3,669.78
|
| Rate for Payer: MDX Hawaii PPO |
$11,482.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3,669.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$3,669.78
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7,102.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$3,669.78
|
| Rate for Payer: University Health Alliance Commercial |
$8,628.72
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139635]
|
Facility
|
OP
|
$13,529.00
|
|
|
Service Code
|
HCPCS J9311
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$13,123.13 |
| Rate for Payer: AlohaCare Medicaid |
$6,764.50
|
| Rate for Payer: AlohaCare Medicare |
$4,193.99
|
| Rate for Payer: Cash Price |
$8,117.40
|
| Rate for Payer: Cash Price |
$8,117.40
|
| Rate for Payer: Devoted Health Medicare |
$4,599.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.96
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4,193.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$36.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12,852.55
|
| Rate for Payer: Health Management Network Commercial |
$11,499.65
|
| Rate for Payer: Humana Medicare |
$4,193.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$12,176.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6,899.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$4,193.99
|
| Rate for Payer: MDX Hawaii PPO |
$13,123.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4,193.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$4,193.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8,117.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$4,193.99
|
| Rate for Payer: University Health Alliance Commercial |
$9,861.29
|
|
|
RITUXIMAB 1,600 MG/13.4 ML (120 MG/ML)-HYALURONIDASE SUBCUTANEOUS SOLN [139635]
|
Facility
|
IP
|
$13,529.00
|
|
|
Service Code
|
HCPCS J9311
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11,499.65 |
| Max. Negotiated Rate |
$13,123.13 |
| Rate for Payer: Cash Price |
$8,117.40
|
| Rate for Payer: Health Management Network Commercial |
$11,499.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$12,176.10
|
| Rate for Payer: MDX Hawaii PPO |
$13,123.13
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION [170115]
|
Facility
|
OP
|
$7,610.00
|
|
|
Service Code
|
HCPCS Q5115
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.18 |
| Max. Negotiated Rate |
$7,381.70 |
| Rate for Payer: AlohaCare Medicaid |
$3,805.00
|
| Rate for Payer: AlohaCare Medicaid |
$4,224.00
|
| Rate for Payer: AlohaCare Medicaid |
$761.00
|
| Rate for Payer: AlohaCare Medicare |
$2,618.88
|
| Rate for Payer: AlohaCare Medicare |
$2,359.10
|
| Rate for Payer: AlohaCare Medicare |
$471.82
|
| Rate for Payer: Cash Price |
$913.20
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Cash Price |
$913.20
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Devoted Health Medicare |
$2,872.32
|
| Rate for Payer: Devoted Health Medicare |
$517.48
|
| Rate for Payer: Devoted Health Medicare |
$2,587.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.18
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$31.18
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.10
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$39.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,618.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$471.82
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,359.10
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$31.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,445.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,025.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7,229.50
|
| Rate for Payer: Health Management Network Commercial |
$1,293.70
|
| Rate for Payer: Health Management Network Commercial |
$7,180.80
|
| Rate for Payer: Health Management Network Commercial |
$6,468.50
|
| Rate for Payer: Humana Medicare |
$2,618.88
|
| Rate for Payer: Humana Medicare |
$2,359.10
|
| Rate for Payer: Humana Medicare |
$471.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,603.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,849.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,369.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3,881.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$776.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,308.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$471.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,359.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,618.88
|
| Rate for Payer: MDX Hawaii PPO |
$8,194.56
|
| Rate for Payer: MDX Hawaii PPO |
$1,476.34
|
| Rate for Payer: MDX Hawaii PPO |
$7,381.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$471.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,359.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,618.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,618.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,359.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$471.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$913.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4,566.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,068.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,359.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$471.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,618.88
|
| Rate for Payer: University Health Alliance Commercial |
$5,546.93
|
| Rate for Payer: University Health Alliance Commercial |
$6,157.75
|
| Rate for Payer: University Health Alliance Commercial |
$1,109.39
|
|
|
RITUXIMAB-ABBS 10 MG/ML INTRAVENOUS SOLUTION [170115]
|
Facility
|
IP
|
$8,448.00
|
|
|
Service Code
|
HCPCS Q5115
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,180.80 |
| Max. Negotiated Rate |
$8,194.56 |
| Rate for Payer: Cash Price |
$5,068.80
|
| Rate for Payer: Cash Price |
$913.20
|
| Rate for Payer: Cash Price |
$4,566.00
|
| Rate for Payer: Health Management Network Commercial |
$7,180.80
|
| Rate for Payer: Health Management Network Commercial |
$6,468.50
|
| Rate for Payer: Health Management Network Commercial |
$1,293.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,369.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$6,849.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,603.20
|
| Rate for Payer: MDX Hawaii PPO |
$7,381.70
|
| Rate for Payer: MDX Hawaii PPO |
$1,476.34
|
| Rate for Payer: MDX Hawaii PPO |
$8,194.56
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [171639]
|
Facility
|
IP
|
$9,548.00
|
|
|
Service Code
|
HCPCS Q5119
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8,115.80 |
| Max. Negotiated Rate |
$9,261.56 |
| Rate for Payer: Cash Price |
$5,728.80
|
| Rate for Payer: Cash Price |
$1,032.60
|
| Rate for Payer: Cash Price |
$5,161.20
|
| Rate for Payer: Health Management Network Commercial |
$8,115.80
|
| Rate for Payer: Health Management Network Commercial |
$7,311.70
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,548.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,741.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,593.20
|
| Rate for Payer: MDX Hawaii PPO |
$8,343.94
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
| Rate for Payer: MDX Hawaii PPO |
$9,261.56
|
|
|
RITUXIMAB-PVVR 10 MG/ML INTRAVENOUS SOLUTION [171639]
|
Facility
|
OP
|
$8,602.00
|
|
|
Service Code
|
HCPCS Q5119
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.11 |
| Max. Negotiated Rate |
$8,343.94 |
| Rate for Payer: AlohaCare Medicaid |
$4,301.00
|
| Rate for Payer: AlohaCare Medicaid |
$4,774.00
|
| Rate for Payer: AlohaCare Medicaid |
$860.50
|
| Rate for Payer: AlohaCare Medicare |
$2,959.88
|
| Rate for Payer: AlohaCare Medicare |
$2,666.62
|
| Rate for Payer: AlohaCare Medicare |
$533.51
|
| Rate for Payer: Cash Price |
$1,032.60
|
| Rate for Payer: Cash Price |
$5,161.20
|
| Rate for Payer: Cash Price |
$5,161.20
|
| Rate for Payer: Cash Price |
$1,032.60
|
| Rate for Payer: Cash Price |
$5,728.80
|
| Rate for Payer: Cash Price |
$5,728.80
|
| Rate for Payer: Devoted Health Medicare |
$3,246.32
|
| Rate for Payer: Devoted Health Medicare |
$585.14
|
| Rate for Payer: Devoted Health Medicare |
$2,924.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,959.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$533.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,666.62
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,634.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9,070.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8,171.90
|
| Rate for Payer: Health Management Network Commercial |
$1,462.85
|
| Rate for Payer: Health Management Network Commercial |
$8,115.80
|
| Rate for Payer: Health Management Network Commercial |
$7,311.70
|
| Rate for Payer: Humana Medicare |
$2,959.88
|
| Rate for Payer: Humana Medicare |
$2,666.62
|
| Rate for Payer: Humana Medicare |
$533.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$8,593.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7,741.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,548.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,387.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$877.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4,869.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$533.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,666.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,959.88
|
| Rate for Payer: MDX Hawaii PPO |
$9,261.56
|
| Rate for Payer: MDX Hawaii PPO |
$1,669.37
|
| Rate for Payer: MDX Hawaii PPO |
$8,343.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$533.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,666.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,959.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,959.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,666.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$533.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1,032.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,161.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5,728.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,666.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$533.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,959.88
|
| Rate for Payer: University Health Alliance Commercial |
$6,270.00
|
| Rate for Payer: University Health Alliance Commercial |
$6,959.54
|
| Rate for Payer: University Health Alliance Commercial |
$1,254.44
|
|
|
RIVAROXABAN 10 MG TABLET [110250]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 50458058010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
RIVAROXABAN 10 MG TABLET [110250]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458058010
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
RIVAROXABAN 10 MG TABLET [110250]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 50458058030
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
RIVAROXABAN 10 MG TABLET [110250]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458058030
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
RIVAROXABAN 15 MG TABLET [112834]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 50458057801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
RIVAROXABAN 15 MG TABLET [112834]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458057801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
RIVAROXABAN 15 MG TABLET [112834]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458057810
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
RIVAROXABAN 15 MG TABLET [112834]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 50458057810
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
RIVAROXABAN 20 MG TABLET [112835]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 50458057990
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
RIVAROXABAN 20 MG TABLET [112835]
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
NDC 50458057901
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51.00 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
|
|
RIVAROXABAN 20 MG TABLET [112835]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458057901
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
RIVAROXABAN 20 MG TABLET [112835]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458057910
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
RIVAROXABAN 20 MG TABLET [112835]
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
NDC 50458057990
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.60 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$18.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Devoted Health Medicare |
$20.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.00
|
| Rate for Payer: Health Management Network Commercial |
$51.00
|
| Rate for Payer: Humana Medicare |
$18.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.60
|
| Rate for Payer: MDX Hawaii PPO |
$58.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.60
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
