|
atenolol 50 mg tablet [HHSC]
|
Facility
|
OP
|
$4.96
|
|
|
Service Code
|
NDC 51079068420
|
| Hospital Charge Code |
2500077
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: AlohaCare Medicaid |
$2.48
|
| Rate for Payer: AlohaCare Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$3.22
|
| Rate for Payer: Devoted Health Medicare |
$2.73
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.71
|
| Rate for Payer: Health Management Network Commercial |
$4.22
|
| Rate for Payer: Humana Medicare |
$2.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.48
|
| Rate for Payer: MDX Hawaii PPO |
$4.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.48
|
| Rate for Payer: University Health Alliance Commercial |
$3.62
|
|
|
ATHEROSCLEROSIS WITH MCC
|
Facility
|
IP
|
$15,272.10
|
|
|
Service Code
|
MSDRG 302
|
| Min. Negotiated Rate |
$15,272.10 |
| Max. Negotiated Rate |
$15,272.10 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,272.10
|
|
|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$15,144.62
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$15,144.62 |
| Max. Negotiated Rate |
$15,144.62 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,144.62
|
|
|
atorvastatin 10 mg tablet [HHSC]
|
Facility
|
IP
|
$3.51
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
2500078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.98 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Health Management Network Commercial |
$2.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.16
|
| Rate for Payer: MDX Hawaii PPO |
$3.40
|
|
|
atorvastatin 10 mg tablet [HHSC]
|
Facility
|
OP
|
$3.51
|
|
|
Service Code
|
NDC 68084009701
|
| Hospital Charge Code |
2500078
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.40 |
| Rate for Payer: AlohaCare Medicaid |
$1.75
|
| Rate for Payer: AlohaCare Medicare |
$1.75
|
| Rate for Payer: Cash Price |
$2.28
|
| Rate for Payer: Devoted Health Medicare |
$1.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.33
|
| Rate for Payer: Health Management Network Commercial |
$2.98
|
| Rate for Payer: Humana Medicare |
$1.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.75
|
| Rate for Payer: MDX Hawaii PPO |
$3.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.75
|
| Rate for Payer: University Health Alliance Commercial |
$2.56
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
IP
|
$4.77
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Health Management Network Commercial |
$4.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.29
|
| Rate for Payer: MDX Hawaii PPO |
$4.63
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 51079020920
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
OP
|
$4.77
|
|
|
Service Code
|
NDC 68084009801
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.38 |
| Max. Negotiated Rate |
$4.63 |
| Rate for Payer: AlohaCare Medicaid |
$2.38
|
| Rate for Payer: AlohaCare Medicare |
$2.38
|
| Rate for Payer: Cash Price |
$3.10
|
| Rate for Payer: Devoted Health Medicare |
$2.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.53
|
| Rate for Payer: Health Management Network Commercial |
$4.05
|
| Rate for Payer: Humana Medicare |
$2.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.29
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.38
|
| Rate for Payer: MDX Hawaii PPO |
$4.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$2.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.38
|
| Rate for Payer: University Health Alliance Commercial |
$3.48
|
|
|
atorvastatin 20 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 51079020920
|
| Hospital Charge Code |
2500079
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
IP
|
$10.80
|
|
|
Service Code
|
NDC 00904629304
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Health Management Network Commercial |
$9.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: MDX Hawaii PPO |
$10.48
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
IP
|
$10.90
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.27 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Health Management Network Commercial |
$9.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.81
|
| Rate for Payer: MDX Hawaii PPO |
$10.57
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
OP
|
$10.80
|
|
|
Service Code
|
NDC 00904629304
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.40 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: AlohaCare Medicaid |
$5.40
|
| Rate for Payer: AlohaCare Medicare |
$5.40
|
| Rate for Payer: Cash Price |
$7.02
|
| Rate for Payer: Devoted Health Medicare |
$5.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.26
|
| Rate for Payer: Health Management Network Commercial |
$9.18
|
| Rate for Payer: Humana Medicare |
$5.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.40
|
| Rate for Payer: MDX Hawaii PPO |
$10.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.48
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.40
|
| Rate for Payer: University Health Alliance Commercial |
$7.87
|
|
|
atorvastatin 80 mg tablet [HHSC]
|
Facility
|
OP
|
$10.90
|
|
|
Service Code
|
NDC 68084059025
|
| Hospital Charge Code |
2500080
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: AlohaCare Medicaid |
$5.45
|
| Rate for Payer: AlohaCare Medicare |
$5.45
|
| Rate for Payer: Cash Price |
$7.09
|
| Rate for Payer: Devoted Health Medicare |
$6.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.36
|
| Rate for Payer: Health Management Network Commercial |
$9.27
|
| Rate for Payer: Humana Medicare |
$5.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.45
|
| Rate for Payer: MDX Hawaii PPO |
$10.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.45
|
| Rate for Payer: University Health Alliance Commercial |
$7.95
|
|
|
atropine 1mg/10ml syringe [HHSC]
|
Facility
|
OP
|
$62.28
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
2500081
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$60.41 |
| Rate for Payer: AlohaCare Medicaid |
$31.14
|
| Rate for Payer: AlohaCare Medicaid |
$37.79
|
| Rate for Payer: AlohaCare Medicaid |
$32.27
|
| Rate for Payer: AlohaCare Medicare |
$32.27
|
| Rate for Payer: AlohaCare Medicare |
$31.14
|
| Rate for Payer: AlohaCare Medicare |
$37.79
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cash Price |
$49.13
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$49.13
|
| Rate for Payer: Devoted Health Medicare |
$34.25
|
| Rate for Payer: Devoted Health Medicare |
$41.57
|
| Rate for Payer: Devoted Health Medicare |
$35.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.27
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.80
|
| Rate for Payer: Health Management Network Commercial |
$64.24
|
| Rate for Payer: Health Management Network Commercial |
$52.94
|
| Rate for Payer: Health Management Network Commercial |
$54.87
|
| Rate for Payer: Humana Medicare |
$31.14
|
| Rate for Payer: Humana Medicare |
$32.27
|
| Rate for Payer: Humana Medicare |
$37.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.79
|
| Rate for Payer: MDX Hawaii PPO |
$73.31
|
| Rate for Payer: MDX Hawaii PPO |
$62.61
|
| Rate for Payer: MDX Hawaii PPO |
$60.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.79
|
| Rate for Payer: University Health Alliance Commercial |
$45.40
|
| Rate for Payer: University Health Alliance Commercial |
$47.05
|
| Rate for Payer: University Health Alliance Commercial |
$55.09
|
|
|
atropine 1mg/10ml syringe [HHSC]
|
Facility
|
IP
|
$75.58
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
2500081
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.24 |
| Max. Negotiated Rate |
$73.31 |
| Rate for Payer: Cash Price |
$49.13
|
| Rate for Payer: Cash Price |
$41.96
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Health Management Network Commercial |
$52.94
|
| Rate for Payer: Health Management Network Commercial |
$64.24
|
| Rate for Payer: Health Management Network Commercial |
$54.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.05
|
| Rate for Payer: MDX Hawaii PPO |
$62.61
|
| Rate for Payer: MDX Hawaii PPO |
$60.41
|
| Rate for Payer: MDX Hawaii PPO |
$73.31
|
|
|
atropine 1 mg/mL vial [HHSC]
|
Facility
|
OP
|
$103.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
2500082
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: AlohaCare Medicaid |
$51.61
|
| Rate for Payer: AlohaCare Medicaid |
$37.81
|
| Rate for Payer: AlohaCare Medicare |
$37.81
|
| Rate for Payer: AlohaCare Medicare |
$51.61
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Devoted Health Medicare |
$56.77
|
| Rate for Payer: Devoted Health Medicare |
$41.59
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$98.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.84
|
| Rate for Payer: Health Management Network Commercial |
$64.28
|
| Rate for Payer: Health Management Network Commercial |
$87.74
|
| Rate for Payer: Humana Medicare |
$51.61
|
| Rate for Payer: Humana Medicare |
$37.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.81
|
| Rate for Payer: MDX Hawaii PPO |
$100.12
|
| Rate for Payer: MDX Hawaii PPO |
$73.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.81
|
| Rate for Payer: University Health Alliance Commercial |
$75.24
|
| Rate for Payer: University Health Alliance Commercial |
$55.12
|
|
|
atropine 1 mg/mL vial [HHSC]
|
Facility
|
IP
|
$103.22
|
|
|
Service Code
|
HCPCS J0461
|
| Hospital Charge Code |
2500082
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.74 |
| Max. Negotiated Rate |
$100.12 |
| Rate for Payer: Cash Price |
$67.09
|
| Rate for Payer: Cash Price |
$49.15
|
| Rate for Payer: Health Management Network Commercial |
$87.74
|
| Rate for Payer: Health Management Network Commercial |
$64.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.06
|
| Rate for Payer: MDX Hawaii PPO |
$73.35
|
| Rate for Payer: MDX Hawaii PPO |
$100.12
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
IP
|
$303.59
|
|
|
Service Code
|
NDC 17478021505
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$294.48 |
| Rate for Payer: Cash Price |
$197.33
|
| Rate for Payer: Health Management Network Commercial |
$258.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.23
|
| Rate for Payer: MDX Hawaii PPO |
$294.48
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
IP
|
$303.59
|
|
|
Service Code
|
NDC 60219174903
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$258.05 |
| Max. Negotiated Rate |
$294.48 |
| Rate for Payer: Cash Price |
$197.33
|
| Rate for Payer: Health Management Network Commercial |
$258.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$273.23
|
| Rate for Payer: MDX Hawaii PPO |
$294.48
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
OP
|
$340.84
|
|
|
Service Code
|
NDC 00065081701
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$170.42 |
| Max. Negotiated Rate |
$330.61 |
| Rate for Payer: AlohaCare Medicaid |
$170.42
|
| Rate for Payer: AlohaCare Medicare |
$170.42
|
| Rate for Payer: Cash Price |
$221.55
|
| Rate for Payer: Devoted Health Medicare |
$187.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$170.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$323.80
|
| Rate for Payer: Health Management Network Commercial |
$289.71
|
| Rate for Payer: Humana Medicare |
$170.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$173.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$170.42
|
| Rate for Payer: MDX Hawaii PPO |
$330.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$170.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$170.42
|
| Rate for Payer: UnitedHealthcare Medicaid |
$204.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$170.42
|
| Rate for Payer: University Health Alliance Commercial |
$248.44
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
IP
|
$340.84
|
|
|
Service Code
|
NDC 00065081701
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$289.71 |
| Max. Negotiated Rate |
$330.61 |
| Rate for Payer: Cash Price |
$221.55
|
| Rate for Payer: Health Management Network Commercial |
$289.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$306.76
|
| Rate for Payer: MDX Hawaii PPO |
$330.61
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
OP
|
$295.45
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$147.72 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: AlohaCare Medicaid |
$147.72
|
| Rate for Payer: AlohaCare Medicare |
$147.72
|
| Rate for Payer: Cash Price |
$192.04
|
| Rate for Payer: Devoted Health Medicare |
$162.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$280.68
|
| Rate for Payer: Health Management Network Commercial |
$251.13
|
| Rate for Payer: Humana Medicare |
$147.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.72
|
| Rate for Payer: MDX Hawaii PPO |
$286.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$177.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.72
|
| Rate for Payer: University Health Alliance Commercial |
$215.35
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
IP
|
$295.45
|
|
|
Service Code
|
NDC 00065030355
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$286.59 |
| Rate for Payer: Cash Price |
$192.04
|
| Rate for Payer: Health Management Network Commercial |
$251.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.90
|
| Rate for Payer: MDX Hawaii PPO |
$286.59
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
OP
|
$293.43
|
|
|
Service Code
|
NDC 60505622601
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$146.72 |
| Max. Negotiated Rate |
$284.63 |
| Rate for Payer: AlohaCare Medicaid |
$146.72
|
| Rate for Payer: AlohaCare Medicare |
$146.72
|
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Devoted Health Medicare |
$161.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$278.76
|
| Rate for Payer: Health Management Network Commercial |
$249.42
|
| Rate for Payer: Humana Medicare |
$146.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$149.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.72
|
| Rate for Payer: MDX Hawaii PPO |
$284.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.72
|
| Rate for Payer: University Health Alliance Commercial |
$213.88
|
|
|
atropine 1% ophth 5ml [HHSC]
|
Facility
|
IP
|
$293.43
|
|
|
Service Code
|
NDC 60505622601
|
| Hospital Charge Code |
2500084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$249.42 |
| Max. Negotiated Rate |
$284.63 |
| Rate for Payer: Cash Price |
$190.73
|
| Rate for Payer: Health Management Network Commercial |
$249.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$264.09
|
| Rate for Payer: MDX Hawaii PPO |
$284.63
|
|
