|
LABETALOL 5 MG/ML IV SOLN
|
Facility
|
OP
|
$11.71
|
|
|
Service Code
|
HCPCS J1920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$11.59 |
| Rate for Payer: AlohaCare Medicaid |
$5.86
|
| Rate for Payer: AlohaCare Medicaid |
$24.14
|
| Rate for Payer: AlohaCare Medicare |
$43.46
|
| Rate for Payer: AlohaCare Medicare |
$10.54
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cash Price |
$31.39
|
| Rate for Payer: Cash Price |
$31.39
|
| Rate for Payer: Devoted Health Medicare |
$47.81
|
| Rate for Payer: Devoted Health Medicare |
$11.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.39
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.88
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.12
|
| Rate for Payer: Health Management Network Commercial |
$41.05
|
| Rate for Payer: Health Management Network Commercial |
$9.95
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Humana Medicare |
$43.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.46
|
| Rate for Payer: MDX Hawaii PPO |
$11.36
|
| Rate for Payer: MDX Hawaii PPO |
$46.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.46
|
| Rate for Payer: University Health Alliance Commercial |
$8.54
|
| Rate for Payer: University Health Alliance Commercial |
$35.20
|
|
|
LABETALOL 5 MG/ML IV SOLN
|
Facility
|
OP
|
$43.46
|
|
|
Service Code
|
HCPCS J1921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.38 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: AlohaCare Medicaid |
$21.73
|
| Rate for Payer: AlohaCare Medicare |
$39.11
|
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Devoted Health Medicare |
$43.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.29
|
| Rate for Payer: Health Management Network Commercial |
$36.94
|
| Rate for Payer: Humana Medicare |
$39.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.11
|
| Rate for Payer: MDX Hawaii PPO |
$42.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.11
|
| Rate for Payer: University Health Alliance Commercial |
$31.68
|
|
|
LABETALOL 5 MG/ML IV SOLN
|
Facility
|
IP
|
$11.71
|
|
|
Service Code
|
HCPCS J1920
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.95 |
| Max. Negotiated Rate |
$11.36 |
| Rate for Payer: Cash Price |
$7.61
|
| Rate for Payer: Cash Price |
$31.39
|
| Rate for Payer: Health Management Network Commercial |
$41.05
|
| Rate for Payer: Health Management Network Commercial |
$9.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.46
|
| Rate for Payer: MDX Hawaii PPO |
$11.36
|
| Rate for Payer: MDX Hawaii PPO |
$46.84
|
|
|
LABETALOL 5 MG/ML IV SOLN
|
Facility
|
IP
|
$43.46
|
|
|
Service Code
|
HCPCS J1921
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.94 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Cash Price |
$28.25
|
| Rate for Payer: Health Management Network Commercial |
$36.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.11
|
| Rate for Payer: MDX Hawaii PPO |
$42.16
|
|
|
LACOSAMIDE 50 MG PO TABLET
|
Facility
|
IP
|
$13.02
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$12.63 |
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Health Management Network Commercial |
$11.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.72
|
| Rate for Payer: MDX Hawaii PPO |
$12.63
|
|
|
LACOSAMIDE 50 MG PO TABLET
|
Facility
|
OP
|
$13.02
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: AlohaCare Medicaid |
$6.51
|
| Rate for Payer: AlohaCare Medicare |
$11.72
|
| Rate for Payer: Cash Price |
$8.46
|
| Rate for Payer: Devoted Health Medicare |
$12.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.37
|
| Rate for Payer: Health Management Network Commercial |
$11.07
|
| Rate for Payer: Humana Medicare |
$11.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.72
|
| Rate for Payer: MDX Hawaii PPO |
$12.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.72
|
| Rate for Payer: University Health Alliance Commercial |
$9.49
|
|
|
LACTATED RINGERS IRRIG SOLN 3000 ML
|
Facility
|
OP
|
$92.52
|
|
|
Service Code
|
NDC 00338013727
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$46.26 |
| Max. Negotiated Rate |
$91.59 |
| Rate for Payer: AlohaCare Medicaid |
$46.26
|
| Rate for Payer: AlohaCare Medicare |
$83.27
|
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Devoted Health Medicare |
$91.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.89
|
| Rate for Payer: Health Management Network Commercial |
$78.64
|
| Rate for Payer: Humana Medicare |
$83.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.27
|
| Rate for Payer: MDX Hawaii PPO |
$89.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.27
|
| Rate for Payer: University Health Alliance Commercial |
$67.44
|
|
|
LACTATED RINGERS IRRIG SOLN 3000 ML
|
Facility
|
IP
|
$92.52
|
|
|
Service Code
|
NDC 00338013727
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$78.64 |
| Max. Negotiated Rate |
$89.74 |
| Rate for Payer: Cash Price |
$60.14
|
| Rate for Payer: Health Management Network Commercial |
$78.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$83.27
|
| Rate for Payer: MDX Hawaii PPO |
$89.74
|
|
|
LACTATED RINGERS IV SOLP 1000 ML
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
HCPCS J7120
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$16.39 |
| Rate for Payer: AlohaCare Medicaid |
$8.28
|
| Rate for Payer: AlohaCare Medicare |
$14.90
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Devoted Health Medicare |
$16.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.73
|
| Rate for Payer: Health Management Network Commercial |
$14.08
|
| Rate for Payer: Humana Medicare |
$14.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.90
|
| Rate for Payer: MDX Hawaii PPO |
$16.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.90
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.90
|
| Rate for Payer: University Health Alliance Commercial |
$12.07
|
|
|
LACTATED RINGERS IV SOLP 1000 ML
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
HCPCS J7120
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$16.06 |
| Rate for Payer: Cash Price |
$10.76
|
| Rate for Payer: Health Management Network Commercial |
$14.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.90
|
| Rate for Payer: MDX Hawaii PPO |
$16.06
|
|
|
LACTOBACILLUS ACIDOPHILUS 20 BILLION CELLS PO CAP
|
Facility
|
IP
|
$2.65
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$2.57 |
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Health Management Network Commercial |
$2.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.38
|
| Rate for Payer: MDX Hawaii PPO |
$2.57
|
|
|
LACTOBACILLUS ACIDOPHILUS 20 BILLION CELLS PO CAP
|
Facility
|
OP
|
$2.65
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: AlohaCare Medicaid |
$1.32
|
| Rate for Payer: AlohaCare Medicare |
$2.38
|
| Rate for Payer: Cash Price |
$1.72
|
| Rate for Payer: Devoted Health Medicare |
$2.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.52
|
| Rate for Payer: Health Management Network Commercial |
$2.25
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.38
|
| Rate for Payer: MDX Hawaii PPO |
$2.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.38
|
| Rate for Payer: University Health Alliance Commercial |
$1.93
|
|
|
LACTULOSE 10 G/15 ML PO SOLN
|
Facility
|
IP
|
$13.58
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$13.17 |
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Health Management Network Commercial |
$11.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.22
|
| Rate for Payer: MDX Hawaii PPO |
$13.17
|
|
|
LACTULOSE 10 G/15 ML PO SOLN
|
Facility
|
OP
|
$13.58
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.79 |
| Max. Negotiated Rate |
$13.44 |
| Rate for Payer: AlohaCare Medicaid |
$6.79
|
| Rate for Payer: AlohaCare Medicare |
$12.22
|
| Rate for Payer: Cash Price |
$8.83
|
| Rate for Payer: Devoted Health Medicare |
$13.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.90
|
| Rate for Payer: Health Management Network Commercial |
$11.54
|
| Rate for Payer: Humana Medicare |
$12.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.22
|
| Rate for Payer: MDX Hawaii PPO |
$13.17
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.22
|
| Rate for Payer: University Health Alliance Commercial |
$9.90
|
|
|
LAMOTRIGINE 25 MG PO TABLET
|
Facility
|
OP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.23 |
| Rate for Payer: AlohaCare Medicaid |
$0.62
|
| Rate for Payer: AlohaCare Medicare |
$1.12
|
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Devoted Health Medicare |
$1.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.18
|
| Rate for Payer: Health Management Network Commercial |
$1.05
|
| Rate for Payer: Humana Medicare |
$1.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.12
|
| Rate for Payer: MDX Hawaii PPO |
$1.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.12
|
| Rate for Payer: University Health Alliance Commercial |
$0.90
|
|
|
LAMOTRIGINE 25 MG PO TABLET
|
Facility
|
IP
|
$1.24
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Cash Price |
$0.81
|
| Rate for Payer: Health Management Network Commercial |
$1.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.12
|
| Rate for Payer: MDX Hawaii PPO |
$1.20
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$26,996.58
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$26,996.58 |
| Max. Negotiated Rate |
$26,996.58 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26,996.58
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$29,603.80
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$29,603.80 |
| Max. Negotiated Rate |
$29,603.80 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$29,603.80
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$17,468.37
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$17,468.37 |
| Max. Negotiated Rate |
$17,468.37 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,468.37
|
|
|
LATANOPROST 0.005 % OPHT DROP
|
Facility
|
IP
|
$427.92
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$363.73 |
| Max. Negotiated Rate |
$415.08 |
| Rate for Payer: Cash Price |
$278.15
|
| Rate for Payer: Cash Price |
$278.76
|
| Rate for Payer: Health Management Network Commercial |
$364.53
|
| Rate for Payer: Health Management Network Commercial |
$363.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.97
|
| Rate for Payer: MDX Hawaii PPO |
$415.08
|
| Rate for Payer: MDX Hawaii PPO |
$415.99
|
|
|
LATANOPROST 0.005 % OPHT DROP
|
Facility
|
OP
|
$427.92
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$213.96 |
| Max. Negotiated Rate |
$423.64 |
| Rate for Payer: AlohaCare Medicaid |
$213.96
|
| Rate for Payer: AlohaCare Medicaid |
$214.43
|
| Rate for Payer: AlohaCare Medicare |
$385.13
|
| Rate for Payer: AlohaCare Medicare |
$385.97
|
| Rate for Payer: Cash Price |
$278.15
|
| Rate for Payer: Cash Price |
$278.76
|
| Rate for Payer: Devoted Health Medicare |
$423.64
|
| Rate for Payer: Devoted Health Medicare |
$424.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$385.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$407.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$406.52
|
| Rate for Payer: Health Management Network Commercial |
$363.73
|
| Rate for Payer: Health Management Network Commercial |
$364.53
|
| Rate for Payer: Humana Medicare |
$385.13
|
| Rate for Payer: Humana Medicare |
$385.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$385.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$218.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$385.97
|
| Rate for Payer: MDX Hawaii PPO |
$415.08
|
| Rate for Payer: MDX Hawaii PPO |
$415.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$385.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$385.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$385.97
|
| Rate for Payer: University Health Alliance Commercial |
$311.91
|
| Rate for Payer: University Health Alliance Commercial |
$312.60
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) PO SOLN
|
Facility
|
IP
|
$43.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.77 |
| Max. Negotiated Rate |
$41.96 |
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Health Management Network Commercial |
$36.77
|
| Rate for Payer: Health Management Network Commercial |
$15.39
|
| Rate for Payer: Health Management Network Commercial |
$15.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.93
|
| Rate for Payer: MDX Hawaii PPO |
$17.62
|
| Rate for Payer: MDX Hawaii PPO |
$17.57
|
| Rate for Payer: MDX Hawaii PPO |
$41.96
|
|
|
LEVETIRACETAM 500 MG/5 ML (5 ML) PO SOLN
|
Facility
|
OP
|
$43.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.63 |
| Max. Negotiated Rate |
$42.83 |
| Rate for Payer: AlohaCare Medicaid |
$21.63
|
| Rate for Payer: AlohaCare Medicaid |
$9.05
|
| Rate for Payer: AlohaCare Medicaid |
$9.09
|
| Rate for Payer: AlohaCare Medicare |
$16.30
|
| Rate for Payer: AlohaCare Medicare |
$38.93
|
| Rate for Payer: AlohaCare Medicare |
$16.35
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cash Price |
$28.12
|
| Rate for Payer: Devoted Health Medicare |
$17.99
|
| Rate for Payer: Devoted Health Medicare |
$17.93
|
| Rate for Payer: Devoted Health Medicare |
$42.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.20
|
| Rate for Payer: Health Management Network Commercial |
$15.39
|
| Rate for Payer: Health Management Network Commercial |
$36.77
|
| Rate for Payer: Health Management Network Commercial |
$15.44
|
| Rate for Payer: Humana Medicare |
$16.30
|
| Rate for Payer: Humana Medicare |
$16.35
|
| Rate for Payer: Humana Medicare |
$38.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.35
|
| Rate for Payer: MDX Hawaii PPO |
$41.96
|
| Rate for Payer: MDX Hawaii PPO |
$17.62
|
| Rate for Payer: MDX Hawaii PPO |
$17.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.30
|
| Rate for Payer: University Health Alliance Commercial |
$31.53
|
| Rate for Payer: University Health Alliance Commercial |
$13.20
|
| Rate for Payer: University Health Alliance Commercial |
$13.24
|
|
|
LEVETIRACETAM 500 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
|
|
|
LEVETIRACETAM 500 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
|
|
