|
OXYBUTYNIN CHLORIDE 5 MG PO TABLET
|
Facility
|
OP
|
$2.42
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$2.40 |
| Rate for Payer: AlohaCare Medicaid |
$1.21
|
| Rate for Payer: AlohaCare Medicare |
$2.18
|
| Rate for Payer: Cash Price |
$1.57
|
| Rate for Payer: Devoted Health Medicare |
$2.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.30
|
| Rate for Payer: Health Management Network Commercial |
$2.06
|
| Rate for Payer: Humana Medicare |
$2.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.18
|
| Rate for Payer: MDX Hawaii PPO |
$2.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.18
|
| Rate for Payer: University Health Alliance Commercial |
$1.76
|
|
|
OXYCODONE 10 MG PO IMMEDIATE RELEASE TABLET
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Health Management Network Commercial |
$4.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$4.60
|
|
|
OXYCODONE 10 MG PO IMMEDIATE RELEASE TABLET
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: AlohaCare Medicaid |
$2.37
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Devoted Health Medicare |
$4.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network Commercial |
$4.03
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$4.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
| Rate for Payer: University Health Alliance Commercial |
$3.45
|
|
|
OXYCODONE 10 MG PO TAB EXTENDED RELEASE 12 H
|
Facility
|
OP
|
$32.11
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.05 |
| Max. Negotiated Rate |
$31.79 |
| Rate for Payer: AlohaCare Medicaid |
$16.05
|
| Rate for Payer: AlohaCare Medicare |
$28.90
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Devoted Health Medicare |
$31.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network Commercial |
$27.29
|
| Rate for Payer: Humana Medicare |
$28.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.90
|
| Rate for Payer: MDX Hawaii PPO |
$31.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.90
|
| Rate for Payer: University Health Alliance Commercial |
$23.40
|
|
|
OXYCODONE 10 MG PO TAB EXTENDED RELEASE 12 H
|
Facility
|
IP
|
$32.11
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.29 |
| Max. Negotiated Rate |
$31.15 |
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Health Management Network Commercial |
$27.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.90
|
| Rate for Payer: MDX Hawaii PPO |
$31.15
|
|
|
OXYCODONE 15 MG PO TABLET
|
Facility
|
IP
|
$10.47
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.90 |
| Max. Negotiated Rate |
$10.16 |
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Health Management Network Commercial |
$8.90
|
| Rate for Payer: Health Management Network Commercial |
$8.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.30
|
| Rate for Payer: MDX Hawaii PPO |
$10.02
|
| Rate for Payer: MDX Hawaii PPO |
$10.16
|
|
|
OXYCODONE 15 MG PO TABLET
|
Facility
|
OP
|
$10.33
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$10.23 |
| Rate for Payer: AlohaCare Medicaid |
$5.17
|
| Rate for Payer: AlohaCare Medicaid |
$5.24
|
| Rate for Payer: AlohaCare Medicare |
$9.30
|
| Rate for Payer: AlohaCare Medicare |
$9.42
|
| Rate for Payer: Cash Price |
$6.81
|
| Rate for Payer: Cash Price |
$6.71
|
| Rate for Payer: Devoted Health Medicare |
$10.23
|
| Rate for Payer: Devoted Health Medicare |
$10.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.81
|
| Rate for Payer: Health Management Network Commercial |
$8.78
|
| Rate for Payer: Health Management Network Commercial |
$8.90
|
| Rate for Payer: Humana Medicare |
$9.42
|
| Rate for Payer: Humana Medicare |
$9.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.30
|
| Rate for Payer: MDX Hawaii PPO |
$10.16
|
| Rate for Payer: MDX Hawaii PPO |
$10.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.42
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.42
|
| Rate for Payer: University Health Alliance Commercial |
$7.63
|
| Rate for Payer: University Health Alliance Commercial |
$7.53
|
|
|
OXYCODONE 5 MG PO IMMEDIATE RELEASE TAB
|
Facility
|
IP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$2.90 |
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Health Management Network Commercial |
$2.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.69
|
| Rate for Payer: MDX Hawaii PPO |
$2.90
|
|
|
OXYCODONE 5 MG PO IMMEDIATE RELEASE TAB
|
Facility
|
OP
|
$2.99
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$2.69
|
| Rate for Payer: Cash Price |
$1.94
|
| Rate for Payer: Devoted Health Medicare |
$2.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.84
|
| Rate for Payer: Health Management Network Commercial |
$2.54
|
| Rate for Payer: Humana Medicare |
$2.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.69
|
| Rate for Payer: MDX Hawaii PPO |
$2.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.69
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.69
|
| Rate for Payer: University Health Alliance Commercial |
$2.18
|
|
|
OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABLET
|
Facility
|
IP
|
$19.71
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Cash Price |
$12.81
|
| Rate for Payer: Health Management Network Commercial |
$16.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.74
|
| Rate for Payer: MDX Hawaii PPO |
$19.12
|
|
|
OXYCODONE-ACETAMINOPHEN 10-325 MG PO TABLET
|
Facility
|
OP
|
$19.71
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$19.51 |
| Rate for Payer: AlohaCare Medicaid |
$9.86
|
| Rate for Payer: AlohaCare Medicare |
$17.74
|
| Rate for Payer: Cash Price |
$12.81
|
| Rate for Payer: Devoted Health Medicare |
$19.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.74
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.72
|
| Rate for Payer: Health Management Network Commercial |
$16.75
|
| Rate for Payer: Humana Medicare |
$17.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.74
|
| Rate for Payer: MDX Hawaii PPO |
$19.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.74
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.74
|
| Rate for Payer: University Health Alliance Commercial |
$14.37
|
|
|
OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABLET
|
Facility
|
IP
|
$7.55
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.42 |
| Max. Negotiated Rate |
$7.32 |
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Health Management Network Commercial |
$6.42
|
| Rate for Payer: Health Management Network Commercial |
$8.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.46
|
| Rate for Payer: MDX Hawaii PPO |
$10.19
|
| Rate for Payer: MDX Hawaii PPO |
$7.32
|
|
|
OXYCODONE-ACETAMINOPHEN 5-325 MG PO TABLET
|
Facility
|
OP
|
$10.51
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: AlohaCare Medicaid |
$5.25
|
| Rate for Payer: AlohaCare Medicaid |
$3.77
|
| Rate for Payer: AlohaCare Medicare |
$9.46
|
| Rate for Payer: AlohaCare Medicare |
$6.79
|
| Rate for Payer: Cash Price |
$4.91
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Devoted Health Medicare |
$10.40
|
| Rate for Payer: Devoted Health Medicare |
$7.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.98
|
| Rate for Payer: Health Management Network Commercial |
$8.93
|
| Rate for Payer: Health Management Network Commercial |
$6.42
|
| Rate for Payer: Humana Medicare |
$6.79
|
| Rate for Payer: Humana Medicare |
$9.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.46
|
| Rate for Payer: MDX Hawaii PPO |
$7.32
|
| Rate for Payer: MDX Hawaii PPO |
$10.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.79
|
| Rate for Payer: University Health Alliance Commercial |
$5.50
|
| Rate for Payer: University Health Alliance Commercial |
$7.66
|
|
|
OXYMETAZOLINE 0.05 % NASAL NON-AER.SPRY
|
Facility
|
OP
|
$40.43
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$40.03 |
| Rate for Payer: AlohaCare Medicaid |
$20.21
|
| Rate for Payer: AlohaCare Medicaid |
$11.02
|
| Rate for Payer: AlohaCare Medicaid |
$19.57
|
| Rate for Payer: AlohaCare Medicare |
$19.83
|
| Rate for Payer: AlohaCare Medicare |
$36.39
|
| Rate for Payer: AlohaCare Medicare |
$35.22
|
| Rate for Payer: Cash Price |
$25.43
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Devoted Health Medicare |
$38.74
|
| Rate for Payer: Devoted Health Medicare |
$21.81
|
| Rate for Payer: Devoted Health Medicare |
$40.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.83
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.39
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.93
|
| Rate for Payer: Health Management Network Commercial |
$18.73
|
| Rate for Payer: Health Management Network Commercial |
$34.37
|
| Rate for Payer: Health Management Network Commercial |
$33.26
|
| Rate for Payer: Humana Medicare |
$19.83
|
| Rate for Payer: Humana Medicare |
$35.22
|
| Rate for Payer: Humana Medicare |
$36.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.39
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.22
|
| Rate for Payer: MDX Hawaii PPO |
$39.22
|
| Rate for Payer: MDX Hawaii PPO |
$37.96
|
| Rate for Payer: MDX Hawaii PPO |
$21.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.39
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.83
|
| Rate for Payer: University Health Alliance Commercial |
$29.47
|
| Rate for Payer: University Health Alliance Commercial |
$16.06
|
| Rate for Payer: University Health Alliance Commercial |
$28.52
|
|
|
OXYMETAZOLINE 0.05 % NASAL NON-AER.SPRY
|
Facility
|
IP
|
$40.43
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.37 |
| Max. Negotiated Rate |
$39.22 |
| Rate for Payer: Cash Price |
$26.28
|
| Rate for Payer: Cash Price |
$25.43
|
| Rate for Payer: Cash Price |
$14.32
|
| Rate for Payer: Health Management Network Commercial |
$34.37
|
| Rate for Payer: Health Management Network Commercial |
$18.73
|
| Rate for Payer: Health Management Network Commercial |
$33.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.39
|
| Rate for Payer: MDX Hawaii PPO |
$37.96
|
| Rate for Payer: MDX Hawaii PPO |
$21.37
|
| Rate for Payer: MDX Hawaii PPO |
$39.22
|
|
|
OXYTOCIN 10 UNIT/ML INJ SOLN
|
Facility
|
IP
|
$19.05
|
|
|
Service Code
|
HCPCS J2590
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$18.48 |
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Health Management Network Commercial |
$16.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.14
|
| Rate for Payer: MDX Hawaii PPO |
$18.48
|
|
|
OXYTOCIN 10 UNIT/ML INJ SOLN
|
Facility
|
OP
|
$19.05
|
|
|
Service Code
|
HCPCS J2590
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: AlohaCare Medicaid |
$9.53
|
| Rate for Payer: AlohaCare Medicare |
$17.14
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Cash Price |
$12.38
|
| Rate for Payer: Devoted Health Medicare |
$18.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.14
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.10
|
| Rate for Payer: Health Management Network Commercial |
$16.19
|
| Rate for Payer: Humana Medicare |
$17.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.14
|
| Rate for Payer: MDX Hawaii PPO |
$18.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.14
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.14
|
| Rate for Payer: University Health Alliance Commercial |
$13.89
|
|
|
PALONOSETRON 0.25 MG/5 ML IV SOLN
|
Facility
|
OP
|
$92.52
|
|
|
Service Code
|
HCPCS J2469
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| 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: Cash Price |
$60.14
|
| Rate for Payer: Devoted Health Medicare |
$91.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.45
|
| 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 Medicaid |
$55.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.27
|
| Rate for Payer: University Health Alliance Commercial |
$67.44
|
|
|
PALONOSETRON 0.25 MG/5 ML IV SOLN
|
Facility
|
IP
|
$92.52
|
|
|
Service Code
|
HCPCS J2469
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$51,646.66
|
|
|
Service Code
|
MSDRG 406
|
| Min. Negotiated Rate |
$51,646.66 |
| Max. Negotiated Rate |
$51,646.66 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$51,646.66
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC
|
Facility
|
IP
|
$93,433.28
|
|
|
Service Code
|
MSDRG 405
|
| Min. Negotiated Rate |
$93,433.28 |
| Max. Negotiated Rate |
$93,433.28 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$93,433.28
|
|
|
PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,022.52
|
|
|
Service Code
|
MSDRG 407
|
| Min. Negotiated Rate |
$37,022.52 |
| Max. Negotiated Rate |
$37,022.52 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37,022.52
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$10,400.00
|
|
|
Service Code
|
MSDRG 010
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$10,400.00 |
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
PANTOPRAZOLE 20 MG PO TAB DR EC
|
Facility
|
OP
|
$61.79
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.89 |
| Max. Negotiated Rate |
$61.17 |
| Rate for Payer: AlohaCare Medicaid |
$30.89
|
| Rate for Payer: AlohaCare Medicaid |
$10.49
|
| Rate for Payer: AlohaCare Medicaid |
$11.00
|
| Rate for Payer: AlohaCare Medicare |
$18.88
|
| Rate for Payer: AlohaCare Medicare |
$19.80
|
| Rate for Payer: AlohaCare Medicare |
$55.61
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$40.16
|
| Rate for Payer: Devoted Health Medicare |
$20.77
|
| Rate for Payer: Devoted Health Medicare |
$21.78
|
| Rate for Payer: Devoted Health Medicare |
$61.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.90
|
| Rate for Payer: Health Management Network Commercial |
$17.83
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Health Management Network Commercial |
$52.52
|
| Rate for Payer: Humana Medicare |
$19.80
|
| Rate for Payer: Humana Medicare |
$55.61
|
| Rate for Payer: Humana Medicare |
$18.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.61
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.61
|
| Rate for Payer: MDX Hawaii PPO |
$20.35
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: MDX Hawaii PPO |
$59.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.80
|
| Rate for Payer: University Health Alliance Commercial |
$16.04
|
| Rate for Payer: University Health Alliance Commercial |
$15.29
|
| Rate for Payer: University Health Alliance Commercial |
$45.04
|
|
|
PANTOPRAZOLE 20 MG PO TAB DR EC
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$21.34 |
| Rate for Payer: Cash Price |
$14.30
|
| Rate for Payer: Cash Price |
$13.64
|
| Rate for Payer: Cash Price |
$40.16
|
| Rate for Payer: Health Management Network Commercial |
$52.52
|
| Rate for Payer: Health Management Network Commercial |
$17.83
|
| Rate for Payer: Health Management Network Commercial |
$18.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.80
|
| Rate for Payer: MDX Hawaii PPO |
$21.34
|
| Rate for Payer: MDX Hawaii PPO |
$20.35
|
| Rate for Payer: MDX Hawaii PPO |
$59.94
|
|
