|
PIN STEINMANN 3.2MM 405800
|
Facility
|
OP
|
$544.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$168.64 |
| Max. Negotiated Rate |
$527.68 |
| Rate for Payer: AlohaCare Medicaid |
$272.00
|
| Rate for Payer: AlohaCare Medicare |
$168.64
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Devoted Health Medicare |
$184.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$168.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.80
|
| Rate for Payer: Health Management Network Commercial |
$462.40
|
| Rate for Payer: Humana Medicare |
$168.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$489.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$277.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$168.64
|
| Rate for Payer: MDX Hawaii PPO |
$527.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$168.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$168.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$168.64
|
| Rate for Payer: University Health Alliance Commercial |
$304.64
|
|
|
PIN STEINMANN 3.2X9 110003484
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$133.61 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: AlohaCare Medicaid |
$215.50
|
| Rate for Payer: AlohaCare Medicare |
$133.61
|
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Devoted Health Medicare |
$146.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$133.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.70
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Humana Medicare |
$133.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$133.61
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$133.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$133.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$133.61
|
| Rate for Payer: University Health Alliance Commercial |
$241.36
|
|
|
PIN STEINMANN 3.2X9 110003484
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.36 |
| Max. Negotiated Rate |
$418.07 |
| Rate for Payer: Cash Price |
$258.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$301.70
|
| Rate for Payer: Health Management Network Commercial |
$366.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.90
|
| Rate for Payer: MDX Hawaii PPO |
$418.07
|
| Rate for Payer: University Health Alliance Commercial |
$241.36
|
|
|
PIN STEINMANN AR-5050K-2
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.55 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: AlohaCare Medicaid |
$102.50
|
| Rate for Payer: AlohaCare Medicare |
$63.55
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Devoted Health Medicare |
$69.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$194.75
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Humana Medicare |
$63.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$104.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.55
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.55
|
| Rate for Payer: University Health Alliance Commercial |
$149.42
|
|
|
PIN STEINMANN AR-5050K-2
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.25 |
| Max. Negotiated Rate |
$198.85 |
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Health Management Network Commercial |
$174.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$184.50
|
| Rate for Payer: MDX Hawaii PPO |
$198.85
|
|
|
PIN TRANSFIX 5050-4-300
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.45 |
| Max. Negotiated Rate |
$771.15 |
| Rate for Payer: AlohaCare Medicaid |
$397.50
|
| Rate for Payer: AlohaCare Medicare |
$246.45
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Devoted Health Medicare |
$270.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$246.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.50
|
| Rate for Payer: Health Management Network Commercial |
$675.75
|
| Rate for Payer: Humana Medicare |
$246.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$715.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$405.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$246.45
|
| Rate for Payer: MDX Hawaii PPO |
$771.15
|
| Rate for Payer: Ohana Health Plan Medicaid |
$246.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$246.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$246.45
|
| Rate for Payer: University Health Alliance Commercial |
$445.20
|
|
|
PIN TRANSFIX 5050-4-300
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.20 |
| Max. Negotiated Rate |
$771.15 |
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.50
|
| Rate for Payer: Health Management Network Commercial |
$675.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$715.50
|
| Rate for Payer: MDX Hawaii PPO |
$771.15
|
| Rate for Payer: University Health Alliance Commercial |
$445.20
|
|
|
PIN VOLAR BUTTRESS 32MM VBP32
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.80 |
| Max. Negotiated Rate |
$1,629.60 |
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,176.00
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,512.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,629.60
|
| Rate for Payer: University Health Alliance Commercial |
$940.80
|
|
|
PIN VOLAR BUTTRESS 32MM VBP32
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,629.60 |
| Rate for Payer: AlohaCare Medicaid |
$840.00
|
| Rate for Payer: AlohaCare Medicare |
$520.80
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Devoted Health Medicare |
$571.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$520.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,176.00
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
| Rate for Payer: Humana Medicare |
$520.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,512.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$856.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$520.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,629.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$520.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$520.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$520.80
|
| Rate for Payer: University Health Alliance Commercial |
$940.80
|
|
|
PIN VOLAR BUTTRESS 42MM VBP42
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.80 |
| Max. Negotiated Rate |
$1,629.60 |
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,176.00
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,512.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,629.60
|
| Rate for Payer: University Health Alliance Commercial |
$940.80
|
|
|
PIN VOLAR BUTTRESS 42MM VBP42
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$1,629.60 |
| Rate for Payer: AlohaCare Medicaid |
$840.00
|
| Rate for Payer: AlohaCare Medicare |
$520.80
|
| Rate for Payer: Cash Price |
$1,008.00
|
| Rate for Payer: Devoted Health Medicare |
$571.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$520.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,176.00
|
| Rate for Payer: Health Management Network Commercial |
$1,428.00
|
| Rate for Payer: Humana Medicare |
$520.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,512.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$856.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$520.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,629.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$520.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$520.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$520.80
|
| Rate for Payer: University Health Alliance Commercial |
$940.80
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
IP
|
$33.00
|
|
|
Service Code
|
NDC 33342005510
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
|
|
PIOGLITAZONE 30 MG TABLET [25529]
|
Facility
|
OP
|
$33.00
|
|
|
Service Code
|
NDC 33342005510
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.23 |
| Max. Negotiated Rate |
$32.01 |
| Rate for Payer: AlohaCare Medicaid |
$16.50
|
| Rate for Payer: AlohaCare Medicare |
$10.23
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Devoted Health Medicare |
$11.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.35
|
| Rate for Payer: Health Management Network Commercial |
$28.05
|
| Rate for Payer: Humana Medicare |
$10.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.23
|
| Rate for Payer: MDX Hawaii PPO |
$32.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.23
|
| Rate for Payer: University Health Alliance Commercial |
$24.05
|
|
|
PIONEER PLUS CATH PPLUS120
|
Facility
|
OP
|
$5,790.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,794.90 |
| Max. Negotiated Rate |
$5,616.30 |
| Rate for Payer: AlohaCare Medicaid |
$2,895.00
|
| Rate for Payer: AlohaCare Medicare |
$1,794.90
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Devoted Health Medicare |
$1,968.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,794.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$5,500.50
|
| Rate for Payer: Health Management Network Commercial |
$4,921.50
|
| Rate for Payer: Humana Medicare |
$1,794.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,211.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,952.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,794.90
|
| Rate for Payer: MDX Hawaii PPO |
$5,616.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,794.90
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,794.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,794.90
|
| Rate for Payer: University Health Alliance Commercial |
$4,220.33
|
|
|
PIONEER PLUS CATH PPLUS120
|
Facility
|
IP
|
$5,790.00
|
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,921.50 |
| Max. Negotiated Rate |
$5,616.30 |
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Health Management Network Commercial |
$4,921.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$5,211.00
|
| Rate for Payer: MDX Hawaii PPO |
$5,616.30
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: AlohaCare Medicaid |
$14.50
|
| Rate for Payer: AlohaCare Medicare |
$8.99
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Devoted Health Medicare |
$9.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.55
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Humana Medicare |
$8.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.99
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.99
|
| Rate for Payer: University Health Alliance Commercial |
$21.14
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM INTRAVENOUS SOLUTION [18304]
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 G/15 ML IV (WET SOLR VIAL) [43018303]
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.90 |
| Max. Negotiated Rate |
$32.98 |
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 G/15 ML IV (WET SOLR VIAL) [43018303]
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicaid |
$17.00
|
| Rate for Payer: AlohaCare Medicare |
$10.54
|
| Rate for Payer: AlohaCare Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$20.40
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$11.56
|
| Rate for Payer: Devoted Health Medicare |
$15.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$32.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.65
|
| Rate for Payer: Health Management Network Commercial |
$28.90
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$10.54
|
| Rate for Payer: Humana Medicare |
$14.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$17.34
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.57
|
| Rate for Payer: MDX Hawaii PPO |
$32.98
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.54
|
| Rate for Payer: University Health Alliance Commercial |
$24.78
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 G IN 50 ML NS ADD-A-VIAL (SIMPLE) [4080103]
|
Facility
|
IP
|
$613.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$521.05 |
| Max. Negotiated Rate |
$594.61 |
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Health Management Network Commercial |
$521.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$551.70
|
| Rate for Payer: MDX Hawaii PPO |
$594.61
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 G IN 50 ML NS ADD-A-VIAL (SIMPLE) [4080103]
|
Facility
|
OP
|
$613.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$594.61 |
| Rate for Payer: AlohaCare Medicaid |
$306.50
|
| Rate for Payer: AlohaCare Medicare |
$190.03
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Cash Price |
$367.80
|
| Rate for Payer: Devoted Health Medicare |
$208.42
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$190.03
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$582.35
|
| Rate for Payer: Health Management Network Commercial |
$521.05
|
| Rate for Payer: Humana Medicare |
$190.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$551.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$312.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$190.03
|
| Rate for Payer: MDX Hawaii PPO |
$594.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$190.03
|
| Rate for Payer: Ohana Health Plan Medicare |
$190.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$367.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$190.03
|
| Rate for Payer: University Health Alliance Commercial |
$446.82
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.10 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM/50 ML DEXTROSE(ISO-OS) IV PIGGYBACK [34524]
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$83.42 |
| Rate for Payer: AlohaCare Medicaid |
$43.00
|
| Rate for Payer: AlohaCare Medicare |
$26.66
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Devoted Health Medicare |
$29.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.70
|
| Rate for Payer: Health Management Network Commercial |
$73.10
|
| Rate for Payer: Humana Medicare |
$26.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.66
|
| Rate for Payer: MDX Hawaii PPO |
$83.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.66
|
| Rate for Payer: University Health Alliance Commercial |
$62.69
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.95 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM INTRAVENOUS SOLUTION [18303]
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$45.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.50
|
| Rate for Payer: AlohaCare Medicare |
$14.57
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Devoted Health Medicare |
$15.98
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.65
|
| Rate for Payer: Health Management Network Commercial |
$39.95
|
| Rate for Payer: Humana Medicare |
$14.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.57
|
| Rate for Payer: MDX Hawaii PPO |
$45.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.57
|
| Rate for Payer: University Health Alliance Commercial |
$34.26
|
|
