|
METHADONE 5 MG PO TABLET
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Health Management Network Commercial |
$1.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.92
|
| Rate for Payer: MDX Hawaii PPO |
$2.07
|
|
|
METHADONE 5 MG PO TABLET
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$2.11 |
| Rate for Payer: AlohaCare Medicaid |
$1.06
|
| Rate for Payer: AlohaCare Medicare |
$1.92
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Devoted Health Medicare |
$2.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.02
|
| Rate for Payer: Health Management Network Commercial |
$1.81
|
| Rate for Payer: Humana Medicare |
$1.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.92
|
| Rate for Payer: MDX Hawaii PPO |
$2.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.92
|
| Rate for Payer: University Health Alliance Commercial |
$1.55
|
|
|
METHIMAZOLE 5 MG PO TABLET
|
Facility
|
IP
|
$3.96
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Health Management Network Commercial |
$3.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.56
|
| Rate for Payer: MDX Hawaii PPO |
$3.84
|
|
|
METHIMAZOLE 5 MG PO TABLET
|
Facility
|
OP
|
$3.96
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: AlohaCare Medicaid |
$1.98
|
| Rate for Payer: AlohaCare Medicare |
$3.56
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Devoted Health Medicare |
$3.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.76
|
| Rate for Payer: Health Management Network Commercial |
$3.37
|
| Rate for Payer: Humana Medicare |
$3.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.56
|
| Rate for Payer: MDX Hawaii PPO |
$3.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.56
|
| Rate for Payer: University Health Alliance Commercial |
$2.89
|
|
|
METHOCARBAMOL 500 MG PO TABLET
|
Facility
|
OP
|
$1.99
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$1.97 |
| Rate for Payer: AlohaCare Medicaid |
$1.00
|
| Rate for Payer: AlohaCare Medicaid |
$0.83
|
| Rate for Payer: AlohaCare Medicare |
$1.49
|
| Rate for Payer: AlohaCare Medicare |
$1.79
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Devoted Health Medicare |
$1.97
|
| Rate for Payer: Devoted Health Medicare |
$1.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.89
|
| Rate for Payer: Health Management Network Commercial |
$1.69
|
| Rate for Payer: Health Management Network Commercial |
$1.41
|
| Rate for Payer: Humana Medicare |
$1.79
|
| Rate for Payer: Humana Medicare |
$1.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.79
|
| Rate for Payer: MDX Hawaii PPO |
$1.61
|
| Rate for Payer: MDX Hawaii PPO |
$1.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.49
|
| Rate for Payer: University Health Alliance Commercial |
$1.45
|
| Rate for Payer: University Health Alliance Commercial |
$1.21
|
|
|
METHOCARBAMOL 500 MG PO TABLET
|
Facility
|
IP
|
$1.66
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.41 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Health Management Network Commercial |
$1.41
|
| Rate for Payer: Health Management Network Commercial |
$1.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.79
|
| Rate for Payer: MDX Hawaii PPO |
$1.93
|
| Rate for Payer: MDX Hawaii PPO |
$1.61
|
|
|
METHOCARBAMOL 750 MG PO TABLET
|
Facility
|
OP
|
$2.06
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$2.04 |
| Rate for Payer: AlohaCare Medicaid |
$1.03
|
| Rate for Payer: AlohaCare Medicare |
$1.85
|
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Devoted Health Medicare |
$2.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.96
|
| Rate for Payer: Health Management Network Commercial |
$1.75
|
| Rate for Payer: Humana Medicare |
$1.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.85
|
| Rate for Payer: MDX Hawaii PPO |
$2.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.85
|
| Rate for Payer: University Health Alliance Commercial |
$1.50
|
|
|
METHOCARBAMOL 750 MG PO TABLET
|
Facility
|
IP
|
$2.06
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$2.00 |
| Rate for Payer: Cash Price |
$1.34
|
| Rate for Payer: Health Management Network Commercial |
$1.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.85
|
| Rate for Payer: MDX Hawaii PPO |
$2.00
|
|
|
METHOTREXATE SODIUM 2.5 MG PO TABLET
|
Facility
|
IP
|
$39.77
|
|
|
Service Code
|
HCPCS J8610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.80 |
| Max. Negotiated Rate |
$38.58 |
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Health Management Network Commercial |
$33.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.79
|
| Rate for Payer: MDX Hawaii PPO |
$38.58
|
|
|
METHOTREXATE SODIUM 2.5 MG PO TABLET
|
Facility
|
OP
|
$39.77
|
|
|
Service Code
|
HCPCS J8610
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$39.37 |
| Rate for Payer: AlohaCare Medicaid |
$19.89
|
| Rate for Payer: AlohaCare Medicare |
$35.79
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Devoted Health Medicare |
$39.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.78
|
| Rate for Payer: Health Management Network Commercial |
$33.80
|
| Rate for Payer: Humana Medicare |
$35.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.79
|
| Rate for Payer: MDX Hawaii PPO |
$38.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.79
|
| Rate for Payer: University Health Alliance Commercial |
$28.99
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN
|
Facility
|
IP
|
$147.50
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.38 |
| Max. Negotiated Rate |
$143.07 |
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Health Management Network Commercial |
$125.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.75
|
| Rate for Payer: MDX Hawaii PPO |
$143.07
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN
|
Facility
|
OP
|
$147.50
|
|
|
Service Code
|
HCPCS J2210
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$146.03 |
| Rate for Payer: AlohaCare Medicaid |
$73.75
|
| Rate for Payer: AlohaCare Medicare |
$132.75
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Cash Price |
$95.88
|
| Rate for Payer: Devoted Health Medicare |
$146.03
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$132.75
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$140.12
|
| Rate for Payer: Health Management Network Commercial |
$125.38
|
| Rate for Payer: Humana Medicare |
$132.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$132.75
|
| Rate for Payer: MDX Hawaii PPO |
$143.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$132.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$132.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$132.75
|
| Rate for Payer: University Health Alliance Commercial |
$107.51
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP
|
Facility
|
OP
|
$65.87
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$65.21 |
| Rate for Payer: AlohaCare Medicaid |
$32.94
|
| Rate for Payer: AlohaCare Medicare |
$59.28
|
| Rate for Payer: Cash Price |
$42.82
|
| Rate for Payer: Cash Price |
$42.82
|
| Rate for Payer: Devoted Health Medicare |
$65.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.28
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.58
|
| Rate for Payer: Health Management Network Commercial |
$55.99
|
| Rate for Payer: Humana Medicare |
$59.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.28
|
| Rate for Payer: MDX Hawaii PPO |
$63.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.28
|
| Rate for Payer: University Health Alliance Commercial |
$48.01
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP
|
Facility
|
IP
|
$65.87
|
|
|
Service Code
|
HCPCS J1010
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.99 |
| Max. Negotiated Rate |
$63.89 |
| Rate for Payer: Cash Price |
$42.82
|
| Rate for Payer: Health Management Network Commercial |
$55.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.28
|
| Rate for Payer: MDX Hawaii PPO |
$63.89
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 500 MG IV RECON.SOLN.
|
Facility
|
OP
|
$118.52
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$117.33 |
| Rate for Payer: UnitedHealthcare Medicaid |
$71.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$106.67
|
| Rate for Payer: AlohaCare Medicaid |
$59.26
|
| Rate for Payer: AlohaCare Medicare |
$106.67
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Devoted Health Medicare |
$117.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$106.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$112.59
|
| Rate for Payer: Health Management Network Commercial |
$100.74
|
| Rate for Payer: Humana Medicare |
$106.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$106.67
|
| Rate for Payer: MDX Hawaii PPO |
$114.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$106.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$106.67
|
| Rate for Payer: University Health Alliance Commercial |
$86.39
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 500 MG IV RECON.SOLN.
|
Facility
|
IP
|
$118.52
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$100.74 |
| Max. Negotiated Rate |
$114.96 |
| Rate for Payer: Cash Price |
$77.04
|
| Rate for Payer: Health Management Network Commercial |
$100.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.67
|
| Rate for Payer: MDX Hawaii PPO |
$114.96
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ RECON.SOLN.
|
Facility
|
IP
|
$40.89
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$39.66 |
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Health Management Network Commercial |
$34.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.80
|
| Rate for Payer: MDX Hawaii PPO |
$39.66
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ RECON.SOLN.
|
Facility
|
OP
|
$40.89
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: AlohaCare Medicaid |
$20.45
|
| Rate for Payer: AlohaCare Medicare |
$36.80
|
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Cash Price |
$26.58
|
| Rate for Payer: Devoted Health Medicare |
$40.48
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.80
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.85
|
| Rate for Payer: Health Management Network Commercial |
$34.76
|
| Rate for Payer: Humana Medicare |
$36.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.80
|
| Rate for Payer: MDX Hawaii PPO |
$39.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.80
|
| Rate for Payer: University Health Alliance Commercial |
$29.80
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 62.5 MG/ML INJ RECON.SOLN.
|
Facility
|
OP
|
$59.99
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$59.39 |
| Rate for Payer: AlohaCare Medicaid |
$30.00
|
| Rate for Payer: AlohaCare Medicare |
$53.99
|
| Rate for Payer: Cash Price |
$38.99
|
| Rate for Payer: Cash Price |
$38.99
|
| Rate for Payer: Devoted Health Medicare |
$59.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$53.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$56.99
|
| Rate for Payer: Health Management Network Commercial |
$50.99
|
| Rate for Payer: Humana Medicare |
$53.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$30.59
|
| Rate for Payer: Kaiser Permanente Medicare |
$53.99
|
| Rate for Payer: MDX Hawaii PPO |
$58.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$53.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$53.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$53.99
|
| Rate for Payer: University Health Alliance Commercial |
$43.73
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 62.5 MG/ML INJ RECON.SOLN.
|
Facility
|
IP
|
$59.99
|
|
|
Service Code
|
HCPCS J2919
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$50.99 |
| Max. Negotiated Rate |
$58.19 |
| Rate for Payer: Cash Price |
$38.99
|
| Rate for Payer: Health Management Network Commercial |
$50.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$53.99
|
| Rate for Payer: MDX Hawaii PPO |
$58.19
|
|
|
METHYL SALICYLATE-MENTHOL 30-10 % TOP CR
|
Facility
|
OP
|
$25.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$25.34 |
| Rate for Payer: AlohaCare Medicaid |
$12.80
|
| Rate for Payer: AlohaCare Medicare |
$23.04
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Devoted Health Medicare |
$25.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.32
|
| Rate for Payer: Health Management Network Commercial |
$21.76
|
| Rate for Payer: Humana Medicare |
$23.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.04
|
| Rate for Payer: MDX Hawaii PPO |
$24.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.04
|
| Rate for Payer: University Health Alliance Commercial |
$18.66
|
|
|
METHYL SALICYLATE-MENTHOL 30-10 % TOP CR
|
Facility
|
IP
|
$25.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.76 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Health Management Network Commercial |
$21.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.04
|
| Rate for Payer: MDX Hawaii PPO |
$24.83
|
|
|
METOCLOPRAMIDE HCL 10 MG PO TABLET
|
Facility
|
OP
|
$1.54
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: AlohaCare Medicaid |
$0.77
|
| Rate for Payer: AlohaCare Medicaid |
$1.99
|
| Rate for Payer: AlohaCare Medicare |
$1.39
|
| Rate for Payer: AlohaCare Medicare |
$3.58
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Devoted Health Medicare |
$1.52
|
| Rate for Payer: Devoted Health Medicare |
$3.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.46
|
| Rate for Payer: Health Management Network Commercial |
$1.31
|
| Rate for Payer: Health Management Network Commercial |
$3.38
|
| Rate for Payer: Humana Medicare |
$3.58
|
| Rate for Payer: Humana Medicare |
$1.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.39
|
| Rate for Payer: MDX Hawaii PPO |
$3.86
|
| Rate for Payer: MDX Hawaii PPO |
$1.49
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.58
|
| Rate for Payer: University Health Alliance Commercial |
$2.90
|
| Rate for Payer: University Health Alliance Commercial |
$1.12
|
|
|
METOCLOPRAMIDE HCL 10 MG PO TABLET
|
Facility
|
IP
|
$3.98
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.38 |
| Max. Negotiated Rate |
$3.86 |
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$1.00
|
| Rate for Payer: Health Management Network Commercial |
$3.38
|
| Rate for Payer: Health Management Network Commercial |
$1.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.39
|
| Rate for Payer: MDX Hawaii PPO |
$1.49
|
| Rate for Payer: MDX Hawaii PPO |
$3.86
|
|
|
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN
|
Facility
|
OP
|
$22.21
|
|
|
Service Code
|
HCPCS J2765
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$21.99 |
| Rate for Payer: AlohaCare Medicaid |
$11.11
|
| Rate for Payer: AlohaCare Medicare |
$19.99
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Cash Price |
$14.44
|
| Rate for Payer: Devoted Health Medicare |
$21.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.10
|
| Rate for Payer: Health Management Network Commercial |
$18.88
|
| Rate for Payer: Humana Medicare |
$19.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.99
|
| Rate for Payer: MDX Hawaii PPO |
$21.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.99
|
| Rate for Payer: University Health Alliance Commercial |
$16.19
|
|
