|
ARIPIPRAZOLE 10 MG PO TABLET
|
Facility
|
IP
|
$141.90
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.61 |
| Max. Negotiated Rate |
$137.64 |
| Rate for Payer: Cash Price |
$92.24
|
| Rate for Payer: Cash Price |
$97.81
|
| Rate for Payer: Health Management Network Commercial |
$127.91
|
| Rate for Payer: Health Management Network Commercial |
$120.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.43
|
| Rate for Payer: MDX Hawaii PPO |
$137.64
|
| Rate for Payer: MDX Hawaii PPO |
$145.97
|
|
|
ARIPIPRAZOLE 10 MG PO TABLET
|
Facility
|
OP
|
$141.90
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: AlohaCare Medicaid |
$70.95
|
| Rate for Payer: AlohaCare Medicaid |
$75.24
|
| Rate for Payer: AlohaCare Medicare |
$127.71
|
| Rate for Payer: AlohaCare Medicare |
$135.43
|
| Rate for Payer: Cash Price |
$92.24
|
| Rate for Payer: Cash Price |
$97.81
|
| Rate for Payer: Devoted Health Medicare |
$140.48
|
| Rate for Payer: Devoted Health Medicare |
$148.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.81
|
| Rate for Payer: Health Management Network Commercial |
$120.61
|
| Rate for Payer: Health Management Network Commercial |
$127.91
|
| Rate for Payer: Humana Medicare |
$127.71
|
| Rate for Payer: Humana Medicare |
$135.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.43
|
| Rate for Payer: MDX Hawaii PPO |
$137.64
|
| Rate for Payer: MDX Hawaii PPO |
$145.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.43
|
| Rate for Payer: University Health Alliance Commercial |
$103.43
|
| Rate for Payer: University Health Alliance Commercial |
$109.68
|
|
|
ARIPIPRAZOLE 15 MG PO TABLET
|
Facility
|
IP
|
$150.48
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Cash Price |
$97.81
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Health Management Network Commercial |
$127.91
|
| Rate for Payer: Health Management Network Commercial |
$10.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.03
|
| Rate for Payer: MDX Hawaii PPO |
$11.89
|
| Rate for Payer: MDX Hawaii PPO |
$145.97
|
|
|
ARIPIPRAZOLE 15 MG PO TABLET
|
Facility
|
OP
|
$12.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$12.14 |
| Rate for Payer: AlohaCare Medicaid |
$6.13
|
| Rate for Payer: AlohaCare Medicaid |
$75.24
|
| Rate for Payer: AlohaCare Medicare |
$11.03
|
| Rate for Payer: AlohaCare Medicare |
$135.43
|
| Rate for Payer: Cash Price |
$97.81
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Devoted Health Medicare |
$12.14
|
| Rate for Payer: Devoted Health Medicare |
$148.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.65
|
| Rate for Payer: Health Management Network Commercial |
$10.42
|
| Rate for Payer: Health Management Network Commercial |
$127.91
|
| Rate for Payer: Humana Medicare |
$135.43
|
| Rate for Payer: Humana Medicare |
$11.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.03
|
| Rate for Payer: MDX Hawaii PPO |
$145.97
|
| Rate for Payer: MDX Hawaii PPO |
$11.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.03
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.43
|
| Rate for Payer: University Health Alliance Commercial |
$109.68
|
| Rate for Payer: University Health Alliance Commercial |
$8.94
|
|
|
ARIPIPRAZOLE 5 MG PO TABLET
|
Facility
|
OP
|
$141.90
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$70.95 |
| Max. Negotiated Rate |
$140.48 |
| Rate for Payer: AlohaCare Medicaid |
$70.95
|
| Rate for Payer: AlohaCare Medicaid |
$75.25
|
| Rate for Payer: AlohaCare Medicare |
$127.71
|
| Rate for Payer: AlohaCare Medicare |
$135.46
|
| Rate for Payer: Cash Price |
$97.83
|
| Rate for Payer: Cash Price |
$92.24
|
| Rate for Payer: Devoted Health Medicare |
$140.48
|
| Rate for Payer: Devoted Health Medicare |
$149.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$135.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$127.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.81
|
| Rate for Payer: Health Management Network Commercial |
$120.61
|
| Rate for Payer: Health Management Network Commercial |
$127.93
|
| Rate for Payer: Humana Medicare |
$135.46
|
| Rate for Payer: Humana Medicare |
$127.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$72.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$135.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$127.71
|
| Rate for Payer: MDX Hawaii PPO |
$145.99
|
| Rate for Payer: MDX Hawaii PPO |
$137.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$127.71
|
| Rate for Payer: Ohana Health Plan Medicaid |
$135.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$127.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$135.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$127.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$135.46
|
| Rate for Payer: University Health Alliance Commercial |
$109.71
|
| Rate for Payer: University Health Alliance Commercial |
$103.43
|
|
|
ARIPIPRAZOLE 5 MG PO TABLET
|
Facility
|
IP
|
$150.51
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.93 |
| Max. Negotiated Rate |
$145.99 |
| Rate for Payer: Cash Price |
$97.83
|
| Rate for Payer: Cash Price |
$92.24
|
| Rate for Payer: Health Management Network Commercial |
$127.93
|
| Rate for Payer: Health Management Network Commercial |
$120.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$135.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$127.71
|
| Rate for Payer: MDX Hawaii PPO |
$137.64
|
| Rate for Payer: MDX Hawaii PPO |
$145.99
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG PO TABLET
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
ASCORBIC ACID (VITAMIN C) 500 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
ASPIRIN 300 MG PR SUPP
|
Facility
|
OP
|
$8.05
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$7.97 |
| Rate for Payer: AlohaCare Medicaid |
$4.03
|
| Rate for Payer: AlohaCare Medicare |
$7.25
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Devoted Health Medicare |
$7.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.65
|
| Rate for Payer: Health Management Network Commercial |
$6.84
|
| Rate for Payer: Humana Medicare |
$7.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.25
|
| Rate for Payer: MDX Hawaii PPO |
$7.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.25
|
| Rate for Payer: University Health Alliance Commercial |
$5.87
|
|
|
ASPIRIN 300 MG PR SUPP
|
Facility
|
IP
|
$8.05
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.84 |
| Max. Negotiated Rate |
$7.81 |
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Health Management Network Commercial |
$6.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.25
|
| Rate for Payer: MDX Hawaii PPO |
$7.81
|
|
|
ASPIRIN 325 MG PO TAB DR EC
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
ASPIRIN 325 MG PO TAB DR EC
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
ASPIRIN 325 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
ASPIRIN 325 MG PO TABLET
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
ASPIRIN 81 MG PO CHEW
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
ASPIRIN 81 MG PO CHEW
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
ASPIRIN 81 MG PO TAB DR EC
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
ASPIRIN 81 MG PO TAB DR EC
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
ASPIRIN-DIPYRIDAMOLE 25-200 MG PO CM12
|
Facility
|
IP
|
$50.01
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.51 |
| Max. Negotiated Rate |
$48.51 |
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Health Management Network Commercial |
$42.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.01
|
| Rate for Payer: MDX Hawaii PPO |
$48.51
|
|
|
ASPIRIN-DIPYRIDAMOLE 25-200 MG PO CM12
|
Facility
|
OP
|
$50.01
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$49.51 |
| Rate for Payer: AlohaCare Medicaid |
$25.00
|
| Rate for Payer: AlohaCare Medicare |
$45.01
|
| Rate for Payer: Cash Price |
$32.51
|
| Rate for Payer: Devoted Health Medicare |
$49.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.51
|
| Rate for Payer: Health Management Network Commercial |
$42.51
|
| Rate for Payer: Humana Medicare |
$45.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.01
|
| Rate for Payer: MDX Hawaii PPO |
$48.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.01
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.01
|
| Rate for Payer: University Health Alliance Commercial |
$36.45
|
|
|
ATENOLOL 25 MG PO TABLET
|
Facility
|
OP
|
$4.42
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$4.38 |
| Rate for Payer: AlohaCare Medicaid |
$2.21
|
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: AlohaCare Medicare |
$3.98
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Devoted Health Medicare |
$4.38
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.20
|
| Rate for Payer: Health Management Network Commercial |
$3.76
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$3.98
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.98
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: MDX Hawaii PPO |
$4.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$3.22
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
ATENOLOL 25 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Cash Price |
$2.87
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Health Management Network Commercial |
$3.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.98
|
| Rate for Payer: MDX Hawaii PPO |
$4.29
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
ATENOLOL 50 MG PO TABLET
|
Facility
|
OP
|
$4.93
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: AlohaCare Medicaid |
$2.46
|
| Rate for Payer: AlohaCare Medicare |
$4.44
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Devoted Health Medicare |
$4.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.68
|
| Rate for Payer: Health Management Network Commercial |
$4.19
|
| Rate for Payer: Humana Medicare |
$4.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.44
|
| Rate for Payer: MDX Hawaii PPO |
$4.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.44
|
| Rate for Payer: University Health Alliance Commercial |
$3.59
|
|
|
ATENOLOL 50 MG PO TABLET
|
Facility
|
IP
|
$4.93
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Health Management Network Commercial |
$4.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.44
|
| Rate for Payer: MDX Hawaii PPO |
$4.78
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$14,197.50
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$14,197.50 |
| Max. Negotiated Rate |
$14,197.50 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,197.50
|
|
