|
DOXAZOSIN 1 MG PO TABLET
|
Facility
|
OP
|
$4.69
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.35 |
| Max. Negotiated Rate |
$4.64 |
| Rate for Payer: AlohaCare Medicaid |
$2.35
|
| Rate for Payer: AlohaCare Medicare |
$4.22
|
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Devoted Health Medicare |
$4.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.22
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.46
|
| Rate for Payer: Health Management Network Commercial |
$3.99
|
| Rate for Payer: Humana Medicare |
$4.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.22
|
| Rate for Payer: MDX Hawaii PPO |
$4.55
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.22
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.22
|
| Rate for Payer: University Health Alliance Commercial |
$3.42
|
|
|
DOXAZOSIN 1 MG PO TABLET
|
Facility
|
IP
|
$4.69
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Cash Price |
$3.05
|
| Rate for Payer: Health Management Network Commercial |
$3.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.22
|
| Rate for Payer: MDX Hawaii PPO |
$4.55
|
|
|
DOXAZOSIN 4 MG PO TABLET
|
Facility
|
OP
|
$7.82
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.91 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: AlohaCare Medicaid |
$3.91
|
| Rate for Payer: AlohaCare Medicare |
$7.04
|
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Devoted Health Medicare |
$7.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.43
|
| Rate for Payer: Health Management Network Commercial |
$6.65
|
| Rate for Payer: Humana Medicare |
$7.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.04
|
| Rate for Payer: MDX Hawaii PPO |
$7.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.04
|
| Rate for Payer: University Health Alliance Commercial |
$5.70
|
|
|
DOXAZOSIN 4 MG PO TABLET
|
Facility
|
IP
|
$7.82
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$7.59 |
| Rate for Payer: Cash Price |
$5.08
|
| Rate for Payer: Health Management Network Commercial |
$6.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.04
|
| Rate for Payer: MDX Hawaii PPO |
$7.59
|
|
|
DOXEPIN 10 MG PO CAP
|
Facility
|
OP
|
$3.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.73 |
| Max. Negotiated Rate |
$3.42 |
| Rate for Payer: AlohaCare Medicaid |
$1.73
|
| Rate for Payer: AlohaCare Medicare |
$3.10
|
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Devoted Health Medicare |
$3.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.28
|
| Rate for Payer: Health Management Network Commercial |
$2.93
|
| Rate for Payer: Humana Medicare |
$3.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.10
|
| Rate for Payer: MDX Hawaii PPO |
$3.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.10
|
| Rate for Payer: University Health Alliance Commercial |
$2.51
|
|
|
DOXEPIN 10 MG PO CAP
|
Facility
|
IP
|
$3.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.93 |
| Max. Negotiated Rate |
$3.35 |
| Rate for Payer: Cash Price |
$2.24
|
| Rate for Payer: Health Management Network Commercial |
$2.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.10
|
| Rate for Payer: MDX Hawaii PPO |
$3.35
|
|
|
DOXEPIN 25 MG PO CAP
|
Facility
|
OP
|
$4.54
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.27 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: AlohaCare Medicaid |
$2.27
|
| Rate for Payer: AlohaCare Medicaid |
$2.33
|
| Rate for Payer: AlohaCare Medicare |
$4.09
|
| Rate for Payer: AlohaCare Medicare |
$4.19
|
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Devoted Health Medicare |
$4.49
|
| Rate for Payer: Devoted Health Medicare |
$4.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.31
|
| Rate for Payer: Health Management Network Commercial |
$3.86
|
| Rate for Payer: Health Management Network Commercial |
$3.96
|
| Rate for Payer: Humana Medicare |
$4.19
|
| Rate for Payer: Humana Medicare |
$4.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.09
|
| Rate for Payer: MDX Hawaii PPO |
$4.52
|
| Rate for Payer: MDX Hawaii PPO |
$4.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.19
|
| Rate for Payer: University Health Alliance Commercial |
$3.40
|
| Rate for Payer: University Health Alliance Commercial |
$3.31
|
|
|
DOXEPIN 25 MG PO CAP
|
Facility
|
IP
|
$4.66
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$4.52 |
| Rate for Payer: Cash Price |
$3.03
|
| Rate for Payer: Cash Price |
$2.95
|
| Rate for Payer: Health Management Network Commercial |
$3.96
|
| Rate for Payer: Health Management Network Commercial |
$3.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.09
|
| Rate for Payer: MDX Hawaii PPO |
$4.40
|
| Rate for Payer: MDX Hawaii PPO |
$4.52
|
|
|
DOXEPIN 50 MG PO CAP
|
Facility
|
OP
|
$6.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.23 |
| Max. Negotiated Rate |
$6.39 |
| Rate for Payer: AlohaCare Medicaid |
$3.23
|
| Rate for Payer: AlohaCare Medicaid |
$3.25
|
| Rate for Payer: AlohaCare Medicare |
$5.80
|
| Rate for Payer: AlohaCare Medicare |
$5.85
|
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$4.19
|
| Rate for Payer: Devoted Health Medicare |
$6.39
|
| Rate for Payer: Devoted Health Medicare |
$6.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.13
|
| Rate for Payer: Health Management Network Commercial |
$5.48
|
| Rate for Payer: Health Management Network Commercial |
$5.53
|
| Rate for Payer: Humana Medicare |
$5.85
|
| Rate for Payer: Humana Medicare |
$5.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.80
|
| Rate for Payer: MDX Hawaii PPO |
$6.30
|
| Rate for Payer: MDX Hawaii PPO |
$6.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.85
|
| Rate for Payer: University Health Alliance Commercial |
$4.74
|
| Rate for Payer: University Health Alliance Commercial |
$4.70
|
|
|
DOXEPIN 50 MG PO CAP
|
Facility
|
IP
|
$6.50
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$6.30 |
| Rate for Payer: Cash Price |
$4.23
|
| Rate for Payer: Cash Price |
$4.19
|
| Rate for Payer: Health Management Network Commercial |
$5.53
|
| Rate for Payer: Health Management Network Commercial |
$5.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.80
|
| Rate for Payer: MDX Hawaii PPO |
$6.26
|
| Rate for Payer: MDX Hawaii PPO |
$6.30
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV RECON.SOLN.
|
Facility
|
OP
|
$127.01
|
|
|
Service Code
|
HCPCS J1271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$125.74 |
| Rate for Payer: AlohaCare Medicaid |
$63.51
|
| Rate for Payer: AlohaCare Medicare |
$114.31
|
| Rate for Payer: Cash Price |
$82.56
|
| Rate for Payer: Cash Price |
$82.56
|
| Rate for Payer: Devoted Health Medicare |
$125.74
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$114.31
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$120.66
|
| Rate for Payer: Health Management Network Commercial |
$107.96
|
| Rate for Payer: Humana Medicare |
$114.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$114.31
|
| Rate for Payer: MDX Hawaii PPO |
$123.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$114.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$114.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.21
|
| Rate for Payer: UnitedHealthcare Medicare |
$114.31
|
| Rate for Payer: University Health Alliance Commercial |
$92.58
|
|
|
DOXYCYCLINE HYCLATE 100 MG IV RECON.SOLN.
|
Facility
|
IP
|
$127.01
|
|
|
Service Code
|
HCPCS J1271
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$107.96 |
| Max. Negotiated Rate |
$123.20 |
| Rate for Payer: Cash Price |
$82.56
|
| Rate for Payer: Health Management Network Commercial |
$107.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.31
|
| Rate for Payer: MDX Hawaii PPO |
$123.20
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO TABLET
|
Facility
|
OP
|
$30.85
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$30.54 |
| Rate for Payer: AlohaCare Medicaid |
$15.43
|
| Rate for Payer: AlohaCare Medicare |
$27.77
|
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Devoted Health Medicare |
$30.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.31
|
| Rate for Payer: Health Management Network Commercial |
$26.22
|
| Rate for Payer: Humana Medicare |
$27.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.77
|
| Rate for Payer: MDX Hawaii PPO |
$29.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.77
|
| Rate for Payer: University Health Alliance Commercial |
$22.49
|
|
|
DOXYCYCLINE HYCLATE 100 MG PO TABLET
|
Facility
|
IP
|
$30.85
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$29.92 |
| Rate for Payer: Cash Price |
$20.05
|
| Rate for Payer: Health Management Network Commercial |
$26.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$27.77
|
| Rate for Payer: MDX Hawaii PPO |
$29.92
|
|
|
DRESSING PETROLATUM XEROFORM 2X2 8884433400 [2700764]
|
Facility
|
IP
|
$3.49
|
|
| Hospital Charge Code |
2700764.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Health Management Network Commercial |
$2.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.14
|
| Rate for Payer: MDX Hawaii PPO |
$3.39
|
|
|
DRESSING PETROLATUM XEROFORM 2X2 8884433400 [2700764]
|
Facility
|
OP
|
$3.49
|
|
| Hospital Charge Code |
2700764.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: AlohaCare Medicaid |
$1.75
|
| Rate for Payer: AlohaCare Medicare |
$3.14
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Devoted Health Medicare |
$3.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.32
|
| Rate for Payer: Health Management Network Commercial |
$2.97
|
| Rate for Payer: Humana Medicare |
$3.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.14
|
| Rate for Payer: MDX Hawaii PPO |
$3.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.14
|
| Rate for Payer: University Health Alliance Commercial |
$2.54
|
|
|
DRESSING PETROLATUM XEROFORM 5X9 8884433605 [2700768]
|
Facility
|
OP
|
$3.91
|
|
| Hospital Charge Code |
2700768.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: AlohaCare Medicaid |
$1.96
|
| Rate for Payer: AlohaCare Medicare |
$3.52
|
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Devoted Health Medicare |
$3.87
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.71
|
| Rate for Payer: Health Management Network Commercial |
$3.32
|
| Rate for Payer: Humana Medicare |
$3.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.52
|
| Rate for Payer: MDX Hawaii PPO |
$3.79
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.52
|
| Rate for Payer: University Health Alliance Commercial |
$2.85
|
|
|
DRESSING PETROLATUM XEROFORM 5X9 8884433605 [2700768]
|
Facility
|
IP
|
$3.91
|
|
| Hospital Charge Code |
2700768.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.32 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Cash Price |
$2.54
|
| Rate for Payer: Health Management Network Commercial |
$3.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.52
|
| Rate for Payer: MDX Hawaii PPO |
$3.79
|
|
|
DROPERIDOL 2.5 MG/ML INJ SOLN
|
Facility
|
OP
|
$56.42
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$55.86 |
| Rate for Payer: AlohaCare Medicaid |
$28.21
|
| Rate for Payer: AlohaCare Medicaid |
$30.50
|
| Rate for Payer: AlohaCare Medicare |
$54.91
|
| Rate for Payer: AlohaCare Medicare |
$50.78
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Cash Price |
$36.67
|
| Rate for Payer: Cash Price |
$36.67
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Devoted Health Medicare |
$55.86
|
| Rate for Payer: Devoted Health Medicare |
$60.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.78
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.36
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.96
|
| Rate for Payer: Health Management Network Commercial |
$51.86
|
| Rate for Payer: Health Management Network Commercial |
$47.96
|
| Rate for Payer: Humana Medicare |
$50.78
|
| Rate for Payer: Humana Medicare |
$54.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.91
|
| Rate for Payer: MDX Hawaii PPO |
$54.73
|
| Rate for Payer: MDX Hawaii PPO |
$59.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.91
|
| Rate for Payer: University Health Alliance Commercial |
$41.12
|
| Rate for Payer: University Health Alliance Commercial |
$44.47
|
|
|
DROPERIDOL 2.5 MG/ML INJ SOLN
|
Facility
|
IP
|
$56.42
|
|
|
Service Code
|
HCPCS J1790
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$54.73 |
| Rate for Payer: Cash Price |
$36.67
|
| Rate for Payer: Cash Price |
$39.66
|
| Rate for Payer: Health Management Network Commercial |
$47.96
|
| Rate for Payer: Health Management Network Commercial |
$51.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.91
|
| Rate for Payer: MDX Hawaii PPO |
$59.18
|
| Rate for Payer: MDX Hawaii PPO |
$54.73
|
|
|
DULOXETINE 20 MG PO CAP DR EC
|
Facility
|
OP
|
$43.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$43.02 |
| Rate for Payer: AlohaCare Medicaid |
$21.73
|
| Rate for Payer: AlohaCare Medicare |
$39.10
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: Devoted Health Medicare |
$43.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.28
|
| Rate for Payer: Health Management Network Commercial |
$36.93
|
| Rate for Payer: Humana Medicare |
$39.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.10
|
| Rate for Payer: MDX Hawaii PPO |
$42.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.10
|
| Rate for Payer: University Health Alliance Commercial |
$31.67
|
|
|
DULOXETINE 20 MG PO CAP DR EC
|
Facility
|
IP
|
$43.45
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.93 |
| Max. Negotiated Rate |
$42.15 |
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: Health Management Network Commercial |
$36.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.10
|
| Rate for Payer: MDX Hawaii PPO |
$42.15
|
|
|
DULOXETINE 30 MG PO CAP DR EC
|
Facility
|
IP
|
$47.58
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Health Management Network Commercial |
$40.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.82
|
| Rate for Payer: MDX Hawaii PPO |
$46.15
|
|
|
DULOXETINE 30 MG PO CAP DR EC
|
Facility
|
OP
|
$47.58
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.79 |
| Max. Negotiated Rate |
$47.10 |
| Rate for Payer: AlohaCare Medicaid |
$23.79
|
| Rate for Payer: AlohaCare Medicare |
$42.82
|
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Devoted Health Medicare |
$47.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.20
|
| Rate for Payer: Health Management Network Commercial |
$40.44
|
| Rate for Payer: Humana Medicare |
$42.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.82
|
| Rate for Payer: MDX Hawaii PPO |
$46.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.82
|
| Rate for Payer: University Health Alliance Commercial |
$34.68
|
|
|
DULOXETINE 60 MG PO CAP DR EC
|
Facility
|
IP
|
$47.58
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.44 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Cash Price |
$30.93
|
| Rate for Payer: Health Management Network Commercial |
$40.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.82
|
| Rate for Payer: MDX Hawaii PPO |
$46.15
|
|
