|
OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 99241
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Cash Price |
$65.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.42
|
| Rate for Payer: Health Management Network Commercial |
$85.00
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 99245
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$181.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$181.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.80
|
| Rate for Payer: Health Management Network Commercial |
$382.50
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 99243
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$89.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$89.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$105.54
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 99244
|
| Min. Negotiated Rate |
$136.13 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$136.13
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$136.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$139.47
|
| Rate for Payer: Health Management Network Commercial |
$293.25
|
|
|
OFFICE/OP CONSLTJ NEW/EST PT SF MDM 20 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99242
|
| Min. Negotiated Rate |
$56.76 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$56.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$56.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$82.11
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
|
|
OFFICE/OUTPATIENT ESTABLISHED HIGH MDM 40-54 MIN
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
HCPCS 99215
|
| Min. Negotiated Rate |
$83.80 |
| Max. Negotiated Rate |
$318.75 |
| Rate for Payer: AlohaCare Medicaid |
$145.89
|
| Rate for Payer: AlohaCare Medicare |
$126.07
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Devoted Health Medicare |
$138.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$145.89
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$145.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.80
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$151.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$145.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$145.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.07
|
|
|
OFFICE/OUTPATIENT ESTABLISHED LOW MDM 20-29 MIN
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 99213
|
| Min. Negotiated Rate |
$42.37 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: AlohaCare Medicaid |
$66.56
|
| Rate for Payer: AlohaCare Medicare |
$57.69
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$63.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$66.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$66.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.37
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$69.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$66.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$66.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.69
|
|
|
OFFICE/OUTPATIENT ESTABLISHED MOD MDM 30-39 MIN
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 99214
|
| Min. Negotiated Rate |
$63.45 |
| Max. Negotiated Rate |
$221.00 |
| Rate for Payer: AlohaCare Medicaid |
$98.27
|
| Rate for Payer: AlohaCare Medicare |
$84.69
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Devoted Health Medicare |
$93.16
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$98.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.69
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$98.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$63.45
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$101.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$101.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$98.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$98.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.69
|
|
|
OFFICE/OUTPATIENT ESTABLISHED SF MDM 10-19 MIN
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS 99212
|
| Min. Negotiated Rate |
$29.59 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: AlohaCare Medicaid |
$35.51
|
| Rate for Payer: AlohaCare Medicare |
$31.00
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Cash Price |
$74.75
|
| Rate for Payer: Devoted Health Medicare |
$34.10
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$35.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$35.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$29.59
|
| Rate for Payer: Health Management Network Commercial |
$97.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$35.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.00
|
|
|
OFFICE/OUTPATIENT EST PT MAY NOT REQ PHYS/QHP
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 99211
|
| Min. Negotiated Rate |
$7.72 |
| Max. Negotiated Rate |
$38.25 |
| Rate for Payer: AlohaCare Medicaid |
$8.86
|
| Rate for Payer: AlohaCare Medicare |
$7.72
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Devoted Health Medicare |
$8.49
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.72
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.86
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.23
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.86
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.72
|
|
|
OFFICE OUTPATIENT NEW 10 MINUTES
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 99201
|
| Min. Negotiated Rate |
$36.31 |
| Max. Negotiated Rate |
$79.90 |
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Cash Price |
$61.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.31
|
| Rate for Payer: Health Management Network Commercial |
$79.90
|
|
|
OFFICE/OUTPATIENT NEW HIGH MDM 60-74 MINUTES
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
HCPCS 99205
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: AlohaCare Medicaid |
$182.72
|
| Rate for Payer: AlohaCare Medicare |
$159.56
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Devoted Health Medicare |
$175.52
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$182.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$159.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$182.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$135.52
|
| Rate for Payer: Health Management Network Commercial |
$382.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$191.47
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$191.47
|
| Rate for Payer: Ohana Health Plan Medicaid |
$182.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$159.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$182.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$159.56
|
|
|
OFFICE/OUTPATIENT NEW LOW MDM 30-44 MINUTES
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 99203
|
| Min. Negotiated Rate |
$70.97 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: AlohaCare Medicaid |
$82.26
|
| Rate for Payer: AlohaCare Medicare |
$70.97
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Cash Price |
$149.50
|
| Rate for Payer: Devoted Health Medicare |
$78.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$82.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$82.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$77.24
|
| Rate for Payer: Health Management Network Commercial |
$195.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$82.26
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$82.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.97
|
|
|
OFFICE/OUTPATIENT NEW MODERATE MDM 45-59 MINUTES
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
HCPCS 99204
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: AlohaCare Medicaid |
$134.25
|
| Rate for Payer: AlohaCare Medicare |
$116.55
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Cash Price |
$224.25
|
| Rate for Payer: Devoted Health Medicare |
$128.21
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$134.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$116.55
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$134.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$112.99
|
| Rate for Payer: Health Management Network Commercial |
$293.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$139.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$139.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$139.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$134.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$116.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$134.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$116.55
|
|
|
OFFICE/OUTPATIENT NEW SF MDM 15-29 MINUTES
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 99202
|
| Min. Negotiated Rate |
$41.15 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: AlohaCare Medicaid |
$47.75
|
| Rate for Payer: AlohaCare Medicare |
$41.15
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Cash Price |
$97.50
|
| Rate for Payer: Devoted Health Medicare |
$45.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$47.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$41.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$47.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.98
|
| Rate for Payer: Health Management Network Commercial |
$127.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$49.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$41.15
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$41.15
|
|
|
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: MDX Hawaii PPO |
$549.64
|
|
|
OFLOXACIN 0.3 % OTIC DROP
|
Facility
|
OP
|
$566.64
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$288.99 |
| Max. Negotiated Rate |
$549.64 |
| Rate for Payer: Cash Price |
$368.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$538.31
|
| Rate for Payer: Health Management Network Commercial |
$481.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$356.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$288.99
|
| Rate for Payer: MDX Hawaii PPO |
$549.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$339.98
|
| Rate for Payer: University Health Alliance Commercial |
$413.02
|
|
|
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 |
$164.97
|
| Rate for Payer: Health Management Network Commercial |
$161.34
|
| Rate for Payer: MDX Hawaii PPO |
$184.12
|
| Rate for Payer: MDX Hawaii PPO |
$188.26
|
|
|
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 |
$184.12 |
| Rate for Payer: Cash Price |
$123.38
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Cash Price |
$126.15
|
| Rate for Payer: Cash Price |
$123.38
|
| 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 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: Kaiser Permanente Commercial |
$119.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$98.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.80
|
| Rate for Payer: MDX Hawaii PPO |
$188.26
|
| Rate for Payer: MDX Hawaii PPO |
$184.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$113.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$116.45
|
| Rate for Payer: University Health Alliance Commercial |
$141.46
|
| Rate for Payer: University Health Alliance Commercial |
$138.35
|
|
|
OLANZAPINE 10 MG PO RAPID DISSOLVING TAB
|
Facility
|
OP
|
$103.87
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.97 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Cash Price |
$67.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.68
|
| Rate for Payer: Health Management Network Commercial |
$88.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.97
|
| Rate for Payer: MDX Hawaii PPO |
$100.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$62.32
|
| 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: MDX Hawaii PPO |
$100.75
|
|
|
OLANZAPINE 20 MG PO TABLET
|
Facility
|
OP
|
$186.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.96 |
| Max. Negotiated Rate |
$180.61 |
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: Cash Price |
$111.40
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$162.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$176.89
|
| Rate for Payer: Health Management Network Commercial |
$3.73
|
| Rate for Payer: Health Management Network Commercial |
$145.68
|
| Rate for Payer: Health Management Network Commercial |
$158.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$107.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$117.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$87.41
|
| Rate for Payer: MDX Hawaii PPO |
$4.26
|
| Rate for Payer: MDX Hawaii PPO |
$166.25
|
| Rate for Payer: MDX Hawaii PPO |
$180.61
|
| Rate for Payer: UnitedHealthcare Medicaid |
$111.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$102.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.63
|
| Rate for Payer: University Health Alliance Commercial |
$3.20
|
| Rate for Payer: University Health Alliance Commercial |
$124.93
|
| Rate for Payer: University Health Alliance Commercial |
$135.72
|
|
|
OLANZAPINE 20 MG PO TABLET
|
Facility
|
IP
|
$186.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$180.61 |
| Rate for Payer: Cash Price |
$121.03
|
| Rate for Payer: Cash Price |
$2.85
|
| Rate for Payer: Cash Price |
$111.40
|
| Rate for Payer: Health Management Network Commercial |
$145.68
|
| Rate for Payer: Health Management Network Commercial |
$158.27
|
| Rate for Payer: Health Management Network Commercial |
$3.73
|
| Rate for Payer: MDX Hawaii PPO |
$166.25
|
| Rate for Payer: MDX Hawaii PPO |
$4.26
|
| Rate for Payer: MDX Hawaii PPO |
$180.61
|
|
|
OLANZAPINE 2.5 MG PO TABLET
|
Facility
|
IP
|
$64.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.62 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Cash Price |
$41.77
|
| Rate for Payer: Cash Price |
$41.83
|
| Rate for Payer: Health Management Network Commercial |
$54.71
|
| Rate for Payer: Health Management Network Commercial |
$54.62
|
| Rate for Payer: MDX Hawaii PPO |
$62.43
|
| Rate for Payer: MDX Hawaii PPO |
$62.33
|
|
|
OLANZAPINE 2.5 MG PO TABLET
|
Facility
|
OP
|
$64.26
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.77 |
| Max. Negotiated Rate |
$62.33 |
| Rate for Payer: Cash Price |
$41.77
|
| Rate for Payer: Cash Price |
$41.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.14
|
| Rate for Payer: Health Management Network Commercial |
$54.71
|
| Rate for Payer: Health Management Network Commercial |
$54.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.77
|
| Rate for Payer: MDX Hawaii PPO |
$62.43
|
| Rate for Payer: MDX Hawaii PPO |
$62.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.62
|
| Rate for Payer: University Health Alliance Commercial |
$46.91
|
| Rate for Payer: University Health Alliance Commercial |
$46.84
|
|
