|
OCTREOTIDE ACETATE 100 MCG/ML INJ SOLN
|
Facility
|
OP
|
$21.53
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$21.31 |
| Rate for Payer: AlohaCare Medicaid |
$10.77
|
| Rate for Payer: AlohaCare Medicare |
$19.38
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Cash Price |
$13.99
|
| Rate for Payer: Devoted Health Medicare |
$21.31
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.45
|
| Rate for Payer: Health Management Network Commercial |
$18.30
|
| Rate for Payer: Humana Medicare |
$19.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.38
|
| Rate for Payer: MDX Hawaii PPO |
$20.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.38
|
| Rate for Payer: University Health Alliance Commercial |
$15.69
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJ SOLN
|
Facility
|
OP
|
$24.84
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$24.59 |
| Rate for Payer: AlohaCare Medicaid |
$12.42
|
| Rate for Payer: AlohaCare Medicare |
$22.36
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Devoted Health Medicare |
$24.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.60
|
| Rate for Payer: Health Management Network Commercial |
$21.11
|
| Rate for Payer: Humana Medicare |
$22.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.36
|
| Rate for Payer: MDX Hawaii PPO |
$24.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$0.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.36
|
| Rate for Payer: University Health Alliance Commercial |
$18.11
|
|
|
OCTREOTIDE ACETATE 50 MCG/ML INJ SOLN
|
Facility
|
IP
|
$24.84
|
|
|
Service Code
|
HCPCS J2354
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$24.09 |
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$21.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.36
|
| Rate for Payer: MDX Hawaii PPO |
$24.09
|
|
|
OFLOXACIN 0.3 % OTIC DROP
|
Facility
|
OP
|
$566.64
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$283.32 |
| Max. Negotiated Rate |
$560.97 |
| Rate for Payer: AlohaCare Medicaid |
$283.32
|
| Rate for Payer: AlohaCare Medicare |
$509.98
|
| Rate for Payer: Cash Price |
$368.32
|
| Rate for Payer: Devoted Health Medicare |
$560.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$509.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$538.31
|
| Rate for Payer: Health Management Network Commercial |
$481.64
|
| Rate for Payer: Humana Medicare |
$509.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$509.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$509.98
|
| Rate for Payer: MDX Hawaii PPO |
$549.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$509.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$509.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$509.98
|
| Rate for Payer: University Health Alliance Commercial |
$413.02
|
|
|
OFLOXACIN 0.3 % OTIC DROP
|
Facility
|
IP
|
$566.64
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$481.64 |
| Max. Negotiated Rate |
$549.64 |
| Rate for Payer: Cash Price |
$368.32
|
| Rate for Payer: Health Management Network Commercial |
$481.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$509.98
|
| Rate for Payer: MDX Hawaii PPO |
$549.64
|
|
|
OLANZAPINE 10 MG IM RECON.SOLN.
|
Facility
|
OP
|
$189.81
|
|
|
Service Code
|
HCPCS J2359
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$187.91 |
| Rate for Payer: AlohaCare Medicaid |
$94.91
|
| Rate for Payer: AlohaCare Medicaid |
$97.04
|
| Rate for Payer: AlohaCare Medicare |
$174.67
|
| Rate for Payer: AlohaCare Medicare |
$170.83
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Devoted Health Medicare |
$187.91
|
| Rate for Payer: Devoted Health Medicare |
$192.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$174.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$180.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$184.38
|
| Rate for Payer: Health Management Network Commercial |
$164.97
|
| Rate for Payer: Health Management Network Commercial |
$161.34
|
| Rate for Payer: Humana Medicare |
$170.83
|
| Rate for Payer: Humana Medicare |
$174.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$174.67
|
| Rate for Payer: MDX Hawaii PPO |
$184.12
|
| Rate for Payer: MDX Hawaii PPO |
$188.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$174.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$174.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$174.67
|
| Rate for Payer: University Health Alliance Commercial |
$138.35
|
| Rate for Payer: University Health Alliance Commercial |
$141.46
|
|
|
OLANZAPINE 10 MG IM RECON.SOLN.
|
Facility
|
IP
|
$189.81
|
|
|
Service Code
|
HCPCS J2359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$161.34 |
| Max. Negotiated Rate |
$184.12 |
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Health Management Network Commercial |
$161.34
|
| Rate for Payer: Health Management Network Commercial |
$164.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$170.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$174.67
|
| Rate for Payer: MDX Hawaii PPO |
$188.26
|
| Rate for Payer: MDX Hawaii PPO |
$184.12
|
|
|
OLANZAPINE 10 MG PO RAPID DISSOLVING TAB
|
Facility
|
OP
|
$103.87
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$102.83 |
| Rate for Payer: AlohaCare Medicaid |
$51.94
|
| Rate for Payer: AlohaCare Medicare |
$93.48
|
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Devoted Health Medicare |
$102.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$93.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.68
|
| Rate for Payer: Health Management Network Commercial |
$88.29
|
| Rate for Payer: Humana Medicare |
$93.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$93.48
|
| Rate for Payer: MDX Hawaii PPO |
$100.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$93.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$93.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$93.48
|
| Rate for Payer: University Health Alliance Commercial |
$75.71
|
|
|
OLANZAPINE 10 MG PO RAPID DISSOLVING TAB
|
Facility
|
IP
|
$103.87
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$88.29 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Health Management Network Commercial |
$88.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$93.48
|
| Rate for Payer: MDX Hawaii PPO |
$100.75
|
|
|
OLANZAPINE 20 MG PO TABLET
|
Facility
|
OP
|
$4.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: AlohaCare Medicaid |
$2.19
|
| Rate for Payer: AlohaCare Medicare |
$3.95
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Devoted Health Medicare |
$4.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.17
|
| Rate for Payer: Health Management Network Commercial |
$3.73
|
| Rate for Payer: Humana Medicare |
$3.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.95
|
| Rate for Payer: MDX Hawaii PPO |
$4.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.95
|
| Rate for Payer: University Health Alliance Commercial |
$3.20
|
|
|
OLANZAPINE 20 MG PO TABLET
|
Facility
|
IP
|
$4.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$4.26 |
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$3.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.95
|
| Rate for Payer: MDX Hawaii PPO |
$4.26
|
|
|
OLANZAPINE 2.5 MG PO TABLET
|
Facility
|
IP
|
$64.36
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.71 |
| Max. Negotiated Rate |
$62.43 |
| Rate for Payer: Cash Price |
$41.83
|
| Rate for Payer: Cash Price |
$41.77
|
| Rate for Payer: Health Management Network Commercial |
$54.71
|
| Rate for Payer: Health Management Network Commercial |
$54.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.83
|
| Rate for Payer: MDX Hawaii PPO |
$62.33
|
| Rate for Payer: MDX Hawaii PPO |
$62.43
|
|
|
OLANZAPINE 2.5 MG PO TABLET
|
Facility
|
OP
|
$64.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$32.13 |
| Max. Negotiated Rate |
$63.62 |
| Rate for Payer: AlohaCare Medicaid |
$32.13
|
| Rate for Payer: AlohaCare Medicaid |
$32.18
|
| Rate for Payer: AlohaCare Medicare |
$57.83
|
| Rate for Payer: AlohaCare Medicare |
$57.92
|
| Rate for Payer: Cash Price |
$41.83
|
| Rate for Payer: Cash Price |
$41.77
|
| Rate for Payer: Devoted Health Medicare |
$63.62
|
| Rate for Payer: Devoted Health Medicare |
$63.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.05
|
| Rate for Payer: Health Management Network Commercial |
$54.62
|
| Rate for Payer: Health Management Network Commercial |
$54.71
|
| Rate for Payer: Humana Medicare |
$57.92
|
| Rate for Payer: Humana Medicare |
$57.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.83
|
| Rate for Payer: MDX Hawaii PPO |
$62.43
|
| Rate for Payer: MDX Hawaii PPO |
$62.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.92
|
| Rate for Payer: University Health Alliance Commercial |
$46.91
|
| Rate for Payer: University Health Alliance Commercial |
$46.84
|
|
|
OLANZAPINE 5 MG PO RAPID DISSOLVING TABS
|
Facility
|
IP
|
$76.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$74.16 |
| Rate for Payer: Cash Price |
$49.69
|
| Rate for Payer: Health Management Network Commercial |
$64.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.81
|
| Rate for Payer: MDX Hawaii PPO |
$74.16
|
|
|
OLANZAPINE 5 MG PO RAPID DISSOLVING TABS
|
Facility
|
OP
|
$76.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$75.69 |
| Rate for Payer: AlohaCare Medicaid |
$38.23
|
| Rate for Payer: AlohaCare Medicare |
$68.81
|
| Rate for Payer: Cash Price |
$49.69
|
| Rate for Payer: Devoted Health Medicare |
$75.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$68.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.63
|
| Rate for Payer: Health Management Network Commercial |
$64.98
|
| Rate for Payer: Humana Medicare |
$68.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$68.81
|
| Rate for Payer: MDX Hawaii PPO |
$74.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$68.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$68.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$68.81
|
| Rate for Payer: University Health Alliance Commercial |
$55.72
|
|
|
OLANZAPINE 5 MG PO TABLET
|
Facility
|
IP
|
$72.72
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.81 |
| Max. Negotiated Rate |
$70.54 |
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Health Management Network Commercial |
$61.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.45
|
| Rate for Payer: MDX Hawaii PPO |
$70.54
|
|
|
OLANZAPINE 5 MG PO TABLET
|
Facility
|
OP
|
$72.72
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$71.99 |
| Rate for Payer: AlohaCare Medicaid |
$36.36
|
| Rate for Payer: AlohaCare Medicare |
$65.45
|
| Rate for Payer: Cash Price |
$47.27
|
| Rate for Payer: Devoted Health Medicare |
$71.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.08
|
| Rate for Payer: Health Management Network Commercial |
$61.81
|
| Rate for Payer: Humana Medicare |
$65.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.09
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.45
|
| Rate for Payer: MDX Hawaii PPO |
$70.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.45
|
| Rate for Payer: University Health Alliance Commercial |
$53.01
|
|
|
ONDANSETRON 4 MG PO ORAL DISINTEGRATING TABLET
|
Facility
|
IP
|
$113.69
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.64 |
| Max. Negotiated Rate |
$110.28 |
| Rate for Payer: Cash Price |
$73.90
|
| Rate for Payer: Cash Price |
$71.70
|
| Rate for Payer: Health Management Network Commercial |
$96.64
|
| Rate for Payer: Health Management Network Commercial |
$93.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.27
|
| Rate for Payer: MDX Hawaii PPO |
$106.99
|
| Rate for Payer: MDX Hawaii PPO |
$110.28
|
|
|
ONDANSETRON 4 MG PO ORAL DISINTEGRATING TABLET
|
Facility
|
OP
|
$110.30
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.15 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: AlohaCare Medicaid |
$55.15
|
| Rate for Payer: AlohaCare Medicaid |
$56.84
|
| Rate for Payer: AlohaCare Medicare |
$99.27
|
| Rate for Payer: AlohaCare Medicare |
$102.32
|
| Rate for Payer: Cash Price |
$73.90
|
| Rate for Payer: Cash Price |
$71.70
|
| Rate for Payer: Devoted Health Medicare |
$109.20
|
| Rate for Payer: Devoted Health Medicare |
$112.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$102.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$99.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.78
|
| Rate for Payer: Health Management Network Commercial |
$93.75
|
| Rate for Payer: Health Management Network Commercial |
$96.64
|
| Rate for Payer: Humana Medicare |
$102.32
|
| Rate for Payer: Humana Medicare |
$99.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$99.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$57.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$56.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$102.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$99.27
|
| Rate for Payer: MDX Hawaii PPO |
$110.28
|
| Rate for Payer: MDX Hawaii PPO |
$106.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$99.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$102.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$99.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$102.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$99.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$102.32
|
| Rate for Payer: University Health Alliance Commercial |
$82.87
|
| Rate for Payer: University Health Alliance Commercial |
$80.40
|
|
|
ONDANSETRON 8 MG PO ORAL DISINTEGRATING TABLET
|
Facility
|
OP
|
$171.73
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$85.86 |
| Max. Negotiated Rate |
$170.01 |
| Rate for Payer: AlohaCare Medicaid |
$85.86
|
| Rate for Payer: AlohaCare Medicaid |
$88.69
|
| Rate for Payer: AlohaCare Medicare |
$154.56
|
| Rate for Payer: AlohaCare Medicare |
$159.65
|
| Rate for Payer: Cash Price |
$115.30
|
| Rate for Payer: Cash Price |
$111.62
|
| Rate for Payer: Devoted Health Medicare |
$170.01
|
| Rate for Payer: Devoted Health Medicare |
$175.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$168.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$163.14
|
| Rate for Payer: Health Management Network Commercial |
$145.97
|
| Rate for Payer: Health Management Network Commercial |
$150.78
|
| Rate for Payer: Humana Medicare |
$159.65
|
| Rate for Payer: Humana Medicare |
$154.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$90.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$159.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.56
|
| Rate for Payer: MDX Hawaii PPO |
$172.07
|
| Rate for Payer: MDX Hawaii PPO |
$166.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$159.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.65
|
| Rate for Payer: University Health Alliance Commercial |
$129.30
|
| Rate for Payer: University Health Alliance Commercial |
$125.17
|
|
|
ONDANSETRON 8 MG PO ORAL DISINTEGRATING TABLET
|
Facility
|
IP
|
$177.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$150.78 |
| Max. Negotiated Rate |
$172.07 |
| Rate for Payer: Cash Price |
$115.30
|
| Rate for Payer: Cash Price |
$111.62
|
| Rate for Payer: Health Management Network Commercial |
$150.78
|
| Rate for Payer: Health Management Network Commercial |
$145.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$159.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$154.56
|
| Rate for Payer: MDX Hawaii PPO |
$166.58
|
| Rate for Payer: MDX Hawaii PPO |
$172.07
|
|
|
ONDANSETRON HCL 2 MG/ML IV SOLN (20 ML MDV)
|
Facility
|
IP
|
$101.88
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$86.60 |
| Max. Negotiated Rate |
$98.82 |
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Health Management Network Commercial |
$86.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.69
|
| Rate for Payer: MDX Hawaii PPO |
$98.82
|
|
|
ONDANSETRON HCL 2 MG/ML IV SOLN (20 ML MDV)
|
Facility
|
OP
|
$101.88
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$100.86 |
| Rate for Payer: AlohaCare Medicaid |
$50.94
|
| Rate for Payer: AlohaCare Medicare |
$91.69
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Cash Price |
$66.22
|
| Rate for Payer: Devoted Health Medicare |
$100.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$91.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$96.79
|
| Rate for Payer: Health Management Network Commercial |
$86.60
|
| Rate for Payer: Humana Medicare |
$91.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$91.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$91.69
|
| Rate for Payer: MDX Hawaii PPO |
$98.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$91.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$91.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$91.69
|
| Rate for Payer: University Health Alliance Commercial |
$74.26
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN 2 ML VIAL
|
Facility
|
IP
|
$3.98
|
|
|
Service Code
|
HCPCS J2405
|
|
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 |
$3.41
|
| Rate for Payer: Health Management Network Commercial |
$4.46
|
| Rate for Payer: Health Management Network Commercial |
$3.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.72
|
| Rate for Payer: MDX Hawaii PPO |
$3.86
|
| Rate for Payer: MDX Hawaii PPO |
$5.09
|
|
|
ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN 2 ML VIAL
|
Facility
|
OP
|
$5.25
|
|
|
Service Code
|
HCPCS J2405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$5.20 |
| Rate for Payer: AlohaCare Medicaid |
$2.62
|
| Rate for Payer: AlohaCare Medicaid |
$1.99
|
| Rate for Payer: AlohaCare Medicare |
$3.58
|
| Rate for Payer: AlohaCare Medicare |
$4.72
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$2.59
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Devoted Health Medicare |
$3.94
|
| Rate for Payer: Devoted Health Medicare |
$5.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.99
|
| Rate for Payer: Health Management Network Commercial |
$3.38
|
| Rate for Payer: Health Management Network Commercial |
$4.46
|
| Rate for Payer: Humana Medicare |
$3.58
|
| Rate for Payer: Humana Medicare |
$4.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.03
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.72
|
| Rate for Payer: MDX Hawaii PPO |
$3.86
|
| Rate for Payer: MDX Hawaii PPO |
$5.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.58
|
| Rate for Payer: University Health Alliance Commercial |
$2.90
|
| Rate for Payer: University Health Alliance Commercial |
$3.83
|
|
