|
CLARITHROMYCIN 250 MG/5 ML ORAL SUSPENSION [12886]
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
NDC 00781602346
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$278.80 |
| Max. Negotiated Rate |
$318.16 |
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Health Management Network Commercial |
$278.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.20
|
| Rate for Payer: MDX Hawaii PPO |
$318.16
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 00527193106
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$14.44
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$15.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$14.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.44
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.44
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 00527193106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 00781196160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
CLARITHROMYCIN 250 MG TABLET [9616]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 00781196160
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$14.44
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$15.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$14.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.44
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.44
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
CLARITHROMYCIN 500 MG TABLET [9617]
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
NDC 00781196260
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.50 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: AlohaCare Medicaid |
$9.50
|
| Rate for Payer: AlohaCare Medicare |
$14.44
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Devoted Health Medicare |
$15.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.05
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Humana Medicare |
$14.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.69
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.44
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.44
|
| Rate for Payer: University Health Alliance Commercial |
$13.85
|
|
|
CLARITHROMYCIN 500 MG TABLET [9617]
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
NDC 00781196260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.15 |
| Max. Negotiated Rate |
$18.43 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Health Management Network Commercial |
$16.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.10
|
| Rate for Payer: MDX Hawaii PPO |
$18.43
|
|
|
CLAVICLE PIN ASSEMBLY 2.5MM
|
Facility
|
OP
|
$3,474.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,737.00 |
| Max. Negotiated Rate |
$3,369.78 |
| Rate for Payer: AlohaCare Medicaid |
$1,737.00
|
| Rate for Payer: AlohaCare Medicare |
$2,640.24
|
| Rate for Payer: Cash Price |
$2,084.40
|
| Rate for Payer: Devoted Health Medicare |
$2,918.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2,640.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,431.80
|
| Rate for Payer: Health Management Network Commercial |
$2,952.90
|
| Rate for Payer: Humana Medicare |
$2,640.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,126.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1,771.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$2,640.24
|
| Rate for Payer: MDX Hawaii PPO |
$3,369.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2,640.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$2,640.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$2,640.24
|
| Rate for Payer: University Health Alliance Commercial |
$1,945.44
|
|
|
CLAVICLE PIN ASSEMBLY 2.5MM
|
Facility
|
IP
|
$3,474.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,945.44 |
| Max. Negotiated Rate |
$3,369.78 |
| Rate for Payer: Cash Price |
$2,084.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2,431.80
|
| Rate for Payer: Health Management Network Commercial |
$2,952.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$3,126.60
|
| Rate for Payer: MDX Hawaii PPO |
$3,369.78
|
| Rate for Payer: University Health Alliance Commercial |
$1,945.44
|
|
|
CLEARIFY VISUAL SYSTEM 21-345
|
Facility
|
IP
|
$312.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$302.64 |
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Health Management Network Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$280.80
|
| Rate for Payer: MDX Hawaii PPO |
$302.64
|
|
|
CLEARIFY VISUAL SYSTEM 21-345
|
Facility
|
OP
|
$312.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$302.64 |
| Rate for Payer: AlohaCare Medicaid |
$156.00
|
| Rate for Payer: AlohaCare Medicare |
$237.12
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Devoted Health Medicare |
$262.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$237.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$296.40
|
| Rate for Payer: Health Management Network Commercial |
$265.20
|
| Rate for Payer: Humana Medicare |
$237.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$280.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$159.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$237.12
|
| Rate for Payer: MDX Hawaii PPO |
$302.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$237.12
|
| Rate for Payer: Ohana Health Plan Medicare |
$237.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$237.12
|
| Rate for Payer: University Health Alliance Commercial |
$227.42
|
|
|
CLEAR-TRAC 6.5X72 #72200427
|
Facility
|
OP
|
$185.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.50 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$140.60
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Devoted Health Medicare |
$155.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$140.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$175.75
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$140.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$140.60
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$140.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$140.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$140.60
|
| Rate for Payer: University Health Alliance Commercial |
$134.85
|
|
|
CLEAR-TRAC 6.5X72 #72200427
|
Facility
|
IP
|
$185.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
CLEAR-TRAC SMOOTH 72201634
|
Facility
|
IP
|
$133.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.05 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
|
|
CLEAR-TRAC SMOOTH 72201634
|
Facility
|
OP
|
$133.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$129.01 |
| Rate for Payer: AlohaCare Medicaid |
$66.50
|
| Rate for Payer: AlohaCare Medicare |
$101.08
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Devoted Health Medicare |
$111.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$101.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.35
|
| Rate for Payer: Health Management Network Commercial |
$113.05
|
| Rate for Payer: Humana Medicare |
$101.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$101.08
|
| Rate for Payer: MDX Hawaii PPO |
$129.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$101.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$101.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$101.08
|
| Rate for Payer: University Health Alliance Commercial |
$96.94
|
|
|
CLEVIDIPINE 50 MG/100 ML INTRAVENOUS EMULSION [160211]
|
Facility
|
IP
|
$741.00
|
|
|
Service Code
|
HCPCS J0759
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$629.85 |
| Max. Negotiated Rate |
$718.77 |
| Rate for Payer: Cash Price |
$444.60
|
| Rate for Payer: Health Management Network Commercial |
$629.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$666.90
|
| Rate for Payer: MDX Hawaii PPO |
$718.77
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicaid |
$3.00
|
| Rate for Payer: AlohaCare Medicaid |
$9.00
|
| Rate for Payer: AlohaCare Medicaid |
$4.00
|
| Rate for Payer: AlohaCare Medicare |
$6.08
|
| Rate for Payer: AlohaCare Medicare |
$13.68
|
| Rate for Payer: AlohaCare Medicare |
$17.48
|
| Rate for Payer: AlohaCare Medicare |
$4.56
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Devoted Health Medicare |
$5.04
|
| Rate for Payer: Devoted Health Medicare |
$19.32
|
| Rate for Payer: Devoted Health Medicare |
$6.72
|
| Rate for Payer: Devoted Health Medicare |
$15.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.48
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Humana Medicare |
$13.68
|
| Rate for Payer: Humana Medicare |
$4.56
|
| Rate for Payer: Humana Medicare |
$17.48
|
| Rate for Payer: Humana Medicare |
$6.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.48
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.48
|
| Rate for Payer: University Health Alliance Commercial |
$13.12
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
| Rate for Payer: University Health Alliance Commercial |
$4.37
|
| Rate for Payer: University Health Alliance Commercial |
$5.83
|
|
|
CLINDAMYCIN 150 MG/ML INJECTION SOLUTION [82301]
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$7.76 |
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Health Management Network Commercial |
$5.10
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$15.30
|
| Rate for Payer: Health Management Network Commercial |
$6.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.20
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: MDX Hawaii PPO |
$17.46
|
| Rate for Payer: MDX Hawaii PPO |
$7.76
|
| Rate for Payer: MDX Hawaii PPO |
$5.82
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
NDC 45802012801
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$343.40 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Health Management Network Commercial |
$343.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.60
|
| Rate for Payer: MDX Hawaii PPO |
$391.88
|
|
|
CLINDAMYCIN 1 % LOTION [19711]
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
NDC 45802012801
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$391.88 |
| Rate for Payer: AlohaCare Medicaid |
$202.00
|
| Rate for Payer: AlohaCare Medicare |
$307.04
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Devoted Health Medicare |
$339.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$307.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$383.80
|
| Rate for Payer: Health Management Network Commercial |
$343.40
|
| Rate for Payer: Humana Medicare |
$307.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$363.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$206.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$307.04
|
| Rate for Payer: MDX Hawaii PPO |
$391.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$307.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$307.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$307.04
|
| Rate for Payer: University Health Alliance Commercial |
$294.48
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM [9624]
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
NDC 00168027740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$388.45 |
| Max. Negotiated Rate |
$443.29 |
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$411.30
|
| Rate for Payer: MDX Hawaii PPO |
$443.29
|
|
|
CLINDAMYCIN 2 % VAGINAL CREAM [9624]
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
NDC 00168027740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$228.50 |
| Max. Negotiated Rate |
$443.29 |
| Rate for Payer: AlohaCare Medicaid |
$228.50
|
| Rate for Payer: AlohaCare Medicare |
$347.32
|
| Rate for Payer: Cash Price |
$274.20
|
| Rate for Payer: Devoted Health Medicare |
$383.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$347.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$434.15
|
| Rate for Payer: Health Management Network Commercial |
$388.45
|
| Rate for Payer: Humana Medicare |
$347.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$411.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$233.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$347.32
|
| Rate for Payer: MDX Hawaii PPO |
$443.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$347.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$347.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$347.32
|
| Rate for Payer: University Health Alliance Commercial |
$333.11
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: AlohaCare Medicaid |
$22.50
|
| Rate for Payer: AlohaCare Medicare |
$34.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Devoted Health Medicare |
$37.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.75
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Humana Medicare |
$34.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.20
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.20
|
| Rate for Payer: University Health Alliance Commercial |
$32.80
|
|
|
CLINDAMYCIN 600 MG/50 ML IN 5 % DEXTROSE INTRAVENOUS PIGGYBACK [9626]
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
HCPCS J0736
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.25 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Health Management Network Commercial |
$38.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.50
|
| Rate for Payer: MDX Hawaii PPO |
$43.65
|
|
|
CLINDAMYCIN 75 MG/5 ML ORAL SOLUTION [37642]
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
NDC 65862059602
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$120.28 |
| Rate for Payer: AlohaCare Medicaid |
$62.00
|
| Rate for Payer: AlohaCare Medicare |
$94.24
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Devoted Health Medicare |
$104.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$94.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$117.80
|
| Rate for Payer: Health Management Network Commercial |
$105.40
|
| Rate for Payer: Humana Medicare |
$94.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$63.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$94.24
|
| Rate for Payer: MDX Hawaii PPO |
$120.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$94.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$94.24
|
| Rate for Payer: UnitedHealthcare Medicare |
$94.24
|
| Rate for Payer: University Health Alliance Commercial |
$90.38
|
|
