|
HYDROXYZINE HCL 10 MG PO TABLET
|
Facility
|
OP
|
$3.59
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: AlohaCare Medicaid |
$1.79
|
| Rate for Payer: AlohaCare Medicaid |
$0.77
|
| Rate for Payer: AlohaCare Medicare |
$1.38
|
| Rate for Payer: AlohaCare Medicare |
$3.23
|
| Rate for Payer: Cash Price |
$0.99
|
| Rate for Payer: Cash Price |
$2.33
|
| Rate for Payer: Devoted Health Medicare |
$3.55
|
| Rate for Payer: Devoted Health Medicare |
$1.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.41
|
| Rate for Payer: Health Management Network Commercial |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$1.30
|
| Rate for Payer: Humana Medicare |
$3.23
|
| Rate for Payer: Humana Medicare |
$1.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.23
|
| Rate for Payer: MDX Hawaii PPO |
$1.48
|
| Rate for Payer: MDX Hawaii PPO |
$3.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.38
|
| Rate for Payer: University Health Alliance Commercial |
$2.62
|
| Rate for Payer: University Health Alliance Commercial |
$1.12
|
|
|
HYDROXYZINE HCL 25 MG PO TABLET
|
Facility
|
OP
|
$2.19
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$2.17 |
| Rate for Payer: AlohaCare Medicaid |
$1.09
|
| Rate for Payer: AlohaCare Medicare |
$1.97
|
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Devoted Health Medicare |
$2.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.08
|
| Rate for Payer: Health Management Network Commercial |
$1.86
|
| Rate for Payer: Humana Medicare |
$1.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.97
|
| Rate for Payer: MDX Hawaii PPO |
$2.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.97
|
| Rate for Payer: University Health Alliance Commercial |
$1.60
|
|
|
HYDROXYZINE HCL 25 MG PO TABLET
|
Facility
|
IP
|
$2.19
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.86 |
| Max. Negotiated Rate |
$2.12 |
| Rate for Payer: Cash Price |
$1.42
|
| Rate for Payer: Health Management Network Commercial |
$1.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.97
|
| Rate for Payer: MDX Hawaii PPO |
$2.12
|
|
|
HYDROXYZINE HCL 50 MG/ML IM SOLN
|
Facility
|
IP
|
$157.56
|
|
|
Service Code
|
HCPCS J3410
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.93 |
| Max. Negotiated Rate |
$152.83 |
| Rate for Payer: Cash Price |
$102.41
|
| Rate for Payer: Health Management Network Commercial |
$133.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.80
|
| Rate for Payer: MDX Hawaii PPO |
$152.83
|
|
|
HYDROXYZINE HCL 50 MG/ML IM SOLN
|
Facility
|
OP
|
$157.56
|
|
|
Service Code
|
HCPCS J3410
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.93 |
| Max. Negotiated Rate |
$155.98 |
| Rate for Payer: AlohaCare Medicaid |
$78.78
|
| Rate for Payer: AlohaCare Medicare |
$141.80
|
| Rate for Payer: Cash Price |
$102.41
|
| Rate for Payer: Cash Price |
$102.41
|
| Rate for Payer: Devoted Health Medicare |
$155.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$141.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$16.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$149.68
|
| Rate for Payer: Health Management Network Commercial |
$133.93
|
| Rate for Payer: Humana Medicare |
$141.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$141.80
|
| Rate for Payer: MDX Hawaii PPO |
$152.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$141.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$141.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$141.80
|
| Rate for Payer: University Health Alliance Commercial |
$114.85
|
|
|
HYDROXYZINE HCL 50 MG PO TABLET
|
Facility
|
OP
|
$6.16
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.10 |
| Rate for Payer: AlohaCare Medicaid |
$3.08
|
| Rate for Payer: AlohaCare Medicare |
$5.54
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Devoted Health Medicare |
$6.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.85
|
| Rate for Payer: Health Management Network Commercial |
$5.24
|
| Rate for Payer: Humana Medicare |
$5.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.54
|
| Rate for Payer: MDX Hawaii PPO |
$5.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.54
|
| Rate for Payer: University Health Alliance Commercial |
$4.49
|
|
|
HYDROXYZINE HCL 50 MG PO TABLET
|
Facility
|
IP
|
$6.16
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$5.98 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$5.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.54
|
| Rate for Payer: MDX Hawaii PPO |
$5.98
|
|
|
HYOSCYAMINE SULFATE 0.125 MG/5 ML PO ELIX
|
Facility
|
IP
|
$6.16
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$5.98 |
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Health Management Network Commercial |
$5.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.54
|
| Rate for Payer: MDX Hawaii PPO |
$5.98
|
|
|
HYOSCYAMINE SULFATE 0.125 MG/5 ML PO ELIX
|
Facility
|
OP
|
$6.16
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$6.10 |
| Rate for Payer: AlohaCare Medicaid |
$3.08
|
| Rate for Payer: AlohaCare Medicare |
$5.54
|
| Rate for Payer: Cash Price |
$4.00
|
| Rate for Payer: Devoted Health Medicare |
$6.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.85
|
| Rate for Payer: Health Management Network Commercial |
$5.24
|
| Rate for Payer: Humana Medicare |
$5.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.54
|
| Rate for Payer: MDX Hawaii PPO |
$5.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.54
|
| Rate for Payer: University Health Alliance Commercial |
$4.49
|
|
|
HYPERTENSION WITH MCC
|
Facility
|
IP
|
$13,699.76
|
|
|
Service Code
|
MSDRG 304
|
| Min. Negotiated Rate |
$13,699.76 |
| Max. Negotiated Rate |
$13,699.76 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,699.76
|
|
|
HYPERTENSION WITHOUT MCC
|
Facility
|
IP
|
$13,699.76
|
|
|
Service Code
|
MSDRG 305
|
| Min. Negotiated Rate |
$13,699.76 |
| Max. Negotiated Rate |
$13,699.76 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,699.76
|
|
|
IBUPROFEN 100 MG/5 ML PO SUSP
|
Facility
|
OP
|
$9.94
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.97 |
| Max. Negotiated Rate |
$9.84 |
| Rate for Payer: AlohaCare Medicaid |
$4.97
|
| Rate for Payer: AlohaCare Medicaid |
$4.03
|
| Rate for Payer: AlohaCare Medicaid |
$2.40
|
| Rate for Payer: AlohaCare Medicaid |
$3.10
|
| Rate for Payer: AlohaCare Medicaid |
$4.33
|
| Rate for Payer: AlohaCare Medicare |
$4.33
|
| Rate for Payer: AlohaCare Medicare |
$5.57
|
| Rate for Payer: AlohaCare Medicare |
$7.25
|
| Rate for Payer: AlohaCare Medicare |
$7.80
|
| Rate for Payer: AlohaCare Medicare |
$8.95
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Devoted Health Medicare |
$7.98
|
| Rate for Payer: Devoted Health Medicare |
$4.76
|
| Rate for Payer: Devoted Health Medicare |
$9.84
|
| Rate for Payer: Devoted Health Medicare |
$8.58
|
| Rate for Payer: Devoted Health Medicare |
$6.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.24
|
| Rate for Payer: Health Management Network Commercial |
$7.37
|
| Rate for Payer: Health Management Network Commercial |
$8.45
|
| Rate for Payer: Health Management Network Commercial |
$6.85
|
| Rate for Payer: Health Management Network Commercial |
$5.26
|
| Rate for Payer: Health Management Network Commercial |
$4.09
|
| Rate for Payer: Humana Medicare |
$5.57
|
| Rate for Payer: Humana Medicare |
$4.33
|
| Rate for Payer: Humana Medicare |
$7.80
|
| Rate for Payer: Humana Medicare |
$8.95
|
| Rate for Payer: Humana Medicare |
$7.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.95
|
| Rate for Payer: MDX Hawaii PPO |
$6.00
|
| Rate for Payer: MDX Hawaii PPO |
$8.41
|
| Rate for Payer: MDX Hawaii PPO |
$7.82
|
| Rate for Payer: MDX Hawaii PPO |
$4.67
|
| Rate for Payer: MDX Hawaii PPO |
$9.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.57
|
| Rate for Payer: University Health Alliance Commercial |
$7.25
|
| Rate for Payer: University Health Alliance Commercial |
$3.51
|
| Rate for Payer: University Health Alliance Commercial |
$4.51
|
| Rate for Payer: University Health Alliance Commercial |
$5.87
|
| Rate for Payer: University Health Alliance Commercial |
$6.32
|
|
|
IBUPROFEN 100 MG/5 ML PO SUSP
|
Facility
|
IP
|
$8.06
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cash Price |
$3.13
|
| Rate for Payer: Cash Price |
$6.46
|
| Rate for Payer: Cash Price |
$5.64
|
| Rate for Payer: Cash Price |
$4.02
|
| Rate for Payer: Health Management Network Commercial |
$6.85
|
| Rate for Payer: Health Management Network Commercial |
$4.09
|
| Rate for Payer: Health Management Network Commercial |
$5.26
|
| Rate for Payer: Health Management Network Commercial |
$7.37
|
| Rate for Payer: Health Management Network Commercial |
$8.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.57
|
| Rate for Payer: MDX Hawaii PPO |
$8.41
|
| Rate for Payer: MDX Hawaii PPO |
$7.82
|
| Rate for Payer: MDX Hawaii PPO |
$4.67
|
| Rate for Payer: MDX Hawaii PPO |
$6.00
|
| Rate for Payer: MDX Hawaii PPO |
$9.64
|
|
|
IBUPROFEN 200 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
IBUPROFEN 200 MG PO TABLET
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
IBUPROFEN 400 MG PO TABLET
|
Facility
|
OP
|
$1.44
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.43 |
| Rate for Payer: AlohaCare Medicaid |
$0.72
|
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: AlohaCare Medicare |
$1.30
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Devoted Health Medicare |
$1.43
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.37
|
| Rate for Payer: Health Management Network Commercial |
$1.22
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.30
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: MDX Hawaii PPO |
$1.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$1.05
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
IBUPROFEN 400 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$0.94
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Health Management Network Commercial |
$1.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.30
|
| Rate for Payer: MDX Hawaii PPO |
$1.40
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
IBUPROFEN 50 MG/1.25 ML PO DRPS
|
Facility
|
OP
|
$45.08
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$44.63 |
| Rate for Payer: AlohaCare Medicaid |
$22.54
|
| Rate for Payer: AlohaCare Medicare |
$40.57
|
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Devoted Health Medicare |
$44.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.83
|
| Rate for Payer: Health Management Network Commercial |
$38.32
|
| Rate for Payer: Humana Medicare |
$40.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.57
|
| Rate for Payer: MDX Hawaii PPO |
$43.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.57
|
| Rate for Payer: University Health Alliance Commercial |
$32.86
|
|
|
IBUPROFEN 50 MG/1.25 ML PO DRPS
|
Facility
|
IP
|
$45.08
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.32 |
| Max. Negotiated Rate |
$43.73 |
| Rate for Payer: Cash Price |
$29.30
|
| Rate for Payer: Health Management Network Commercial |
$38.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.57
|
| Rate for Payer: MDX Hawaii PPO |
$43.73
|
|
|
IBUPROFEN 600 MG PO TABLET
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$3.00 |
| Rate for Payer: AlohaCare Medicaid |
$1.51
|
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: AlohaCare Medicare |
$2.73
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Devoted Health Medicare |
$3.00
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.88
|
| Rate for Payer: Health Management Network Commercial |
$2.58
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$2.73
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.73
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: MDX Hawaii PPO |
$2.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.73
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$2.21
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
IBUPROFEN 600 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$1.97
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Health Management Network Commercial |
$2.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.73
|
| Rate for Payer: MDX Hawaii PPO |
$2.94
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
IMIPENEM-CILASTATIN 500 MG IV RECON.SOLN.
|
Facility
|
OP
|
$142.12
|
|
|
Service Code
|
HCPCS J0743
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$140.70 |
| Rate for Payer: AlohaCare Medicaid |
$71.06
|
| Rate for Payer: AlohaCare Medicaid |
$49.58
|
| Rate for Payer: AlohaCare Medicaid |
$32.22
|
| Rate for Payer: AlohaCare Medicare |
$57.99
|
| Rate for Payer: AlohaCare Medicare |
$127.91
|
| Rate for Payer: AlohaCare Medicare |
$89.23
|
| Rate for Payer: Cash Price |
$41.88
|
| Rate for Payer: Cash Price |
$64.45
|
| Rate for Payer: Cash Price |
$41.88
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Cash Price |
$64.45
|
| Rate for Payer: Devoted Health Medicare |
$140.70
|
| Rate for Payer: Devoted Health Medicare |
$98.16
|
| Rate for Payer: Devoted Health Medicare |
$63.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$94.19
|
| Rate for Payer: Health Management Network Commercial |
$84.28
|
| Rate for Payer: Health Management Network Commercial |
$120.80
|
| Rate for Payer: Health Management Network Commercial |
$54.77
|
| Rate for Payer: Humana Medicare |
$127.91
|
| Rate for Payer: Humana Medicare |
$57.99
|
| Rate for Payer: Humana Medicare |
$89.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$50.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.23
|
| Rate for Payer: MDX Hawaii PPO |
$96.18
|
| Rate for Payer: MDX Hawaii PPO |
$62.50
|
| Rate for Payer: MDX Hawaii PPO |
$137.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.23
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$85.27
|
| Rate for Payer: UnitedHealthcare Medicaid |
$59.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.23
|
| Rate for Payer: University Health Alliance Commercial |
$103.59
|
| Rate for Payer: University Health Alliance Commercial |
$46.96
|
| Rate for Payer: University Health Alliance Commercial |
$72.27
|
|
|
IMIPENEM-CILASTATIN 500 MG IV RECON.SOLN.
|
Facility
|
IP
|
$99.15
|
|
|
Service Code
|
HCPCS J0743
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$96.18 |
| Rate for Payer: Cash Price |
$64.45
|
| Rate for Payer: Cash Price |
$41.88
|
| Rate for Payer: Cash Price |
$92.38
|
| Rate for Payer: Health Management Network Commercial |
$120.80
|
| Rate for Payer: Health Management Network Commercial |
$84.28
|
| Rate for Payer: Health Management Network Commercial |
$54.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$89.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.91
|
| Rate for Payer: MDX Hawaii PPO |
$62.50
|
| Rate for Payer: MDX Hawaii PPO |
$137.86
|
| Rate for Payer: MDX Hawaii PPO |
$96.18
|
|
|
IMMUNE GLOB G (IGG)-GLYCINE 15-18 % RANGE IM SOLN
|
Facility
|
IP
|
$455.99
|
|
|
Service Code
|
HCPCS J1460
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$387.59 |
| Max. Negotiated Rate |
$442.31 |
| Rate for Payer: Cash Price |
$296.39
|
| Rate for Payer: Health Management Network Commercial |
$387.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$410.39
|
| Rate for Payer: MDX Hawaii PPO |
$442.31
|
|
|
IMMUNE GLOB G (IGG)-GLYCINE 15-18 % RANGE IM SOLN
|
Facility
|
OP
|
$455.99
|
|
|
Service Code
|
HCPCS J1460
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.42 |
| Max. Negotiated Rate |
$451.43 |
| Rate for Payer: AlohaCare Medicaid |
$228.00
|
| Rate for Payer: AlohaCare Medicare |
$410.39
|
| Rate for Payer: Cash Price |
$296.39
|
| Rate for Payer: Cash Price |
$296.39
|
| Rate for Payer: Devoted Health Medicare |
$451.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.42
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$61.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$410.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$48.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$433.19
|
| Rate for Payer: Health Management Network Commercial |
$387.59
|
| Rate for Payer: Humana Medicare |
$410.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$410.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$232.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$410.39
|
| Rate for Payer: MDX Hawaii PPO |
$442.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$410.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$410.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$273.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$410.39
|
| Rate for Payer: University Health Alliance Commercial |
$332.37
|
|
