|
bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]
|
Facility
|
IP
|
$28.62
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
2500125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$27.76 |
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Health Management Network Commercial |
$24.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.76
|
| Rate for Payer: MDX Hawaii PPO |
$27.76
|
|
|
bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]
|
Facility
|
IP
|
$54.68
|
|
|
Service Code
|
NDC 63323046837
|
| Hospital Charge Code |
2500125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$53.04 |
| Rate for Payer: Cash Price |
$35.54
|
| Rate for Payer: Health Management Network Commercial |
$46.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.21
|
| Rate for Payer: MDX Hawaii PPO |
$53.04
|
|
|
bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]
|
Facility
|
OP
|
$28.62
|
|
|
Service Code
|
NDC 00409904217
|
| Hospital Charge Code |
2500125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.31 |
| Max. Negotiated Rate |
$27.76 |
| Rate for Payer: AlohaCare Medicaid |
$14.31
|
| Rate for Payer: AlohaCare Medicare |
$14.31
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Devoted Health Medicare |
$15.74
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.19
|
| Rate for Payer: Health Management Network Commercial |
$24.33
|
| Rate for Payer: Humana Medicare |
$14.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$25.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.31
|
| Rate for Payer: MDX Hawaii PPO |
$27.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.31
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.31
|
| Rate for Payer: University Health Alliance Commercial |
$20.86
|
|
|
bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]
|
Facility
|
OP
|
$65.66
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
2500125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$63.69 |
| Rate for Payer: AlohaCare Medicaid |
$32.83
|
| Rate for Payer: AlohaCare Medicare |
$32.83
|
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Devoted Health Medicare |
$36.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.38
|
| Rate for Payer: Health Management Network Commercial |
$55.81
|
| Rate for Payer: Humana Medicare |
$32.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.83
|
| Rate for Payer: MDX Hawaii PPO |
$63.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.83
|
| Rate for Payer: University Health Alliance Commercial |
$47.86
|
|
|
bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]
|
Facility
|
IP
|
$65.66
|
|
|
Service Code
|
NDC 00409174630
|
| Hospital Charge Code |
2500125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.81 |
| Max. Negotiated Rate |
$63.69 |
| Rate for Payer: Cash Price |
$42.68
|
| Rate for Payer: Health Management Network Commercial |
$55.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$59.09
|
| Rate for Payer: MDX Hawaii PPO |
$63.69
|
|
|
bupivac-0.25% EPI 1:200,000 (PF) vial 30ml [HHSC]
|
Facility
|
OP
|
$76.34
|
|
|
Service Code
|
NDC 00409154110
|
| Hospital Charge Code |
2500125
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.17 |
| Max. Negotiated Rate |
$74.05 |
| Rate for Payer: AlohaCare Medicaid |
$38.17
|
| Rate for Payer: AlohaCare Medicare |
$38.17
|
| Rate for Payer: Cash Price |
$49.62
|
| Rate for Payer: Devoted Health Medicare |
$41.99
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$72.52
|
| Rate for Payer: Health Management Network Commercial |
$64.89
|
| Rate for Payer: Humana Medicare |
$38.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$68.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.17
|
| Rate for Payer: MDX Hawaii PPO |
$74.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$45.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.17
|
| Rate for Payer: University Health Alliance Commercial |
$55.64
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
OP
|
$32.88
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.44 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: AlohaCare Medicaid |
$16.44
|
| Rate for Payer: AlohaCare Medicare |
$16.44
|
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Devoted Health Medicare |
$18.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$16.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network Commercial |
$27.95
|
| Rate for Payer: Humana Medicare |
$16.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$16.44
|
| Rate for Payer: MDX Hawaii PPO |
$31.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$16.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$16.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$16.44
|
| Rate for Payer: University Health Alliance Commercial |
$23.97
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
IP
|
$44.22
|
|
|
Service Code
|
NDC 00409420810
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.59 |
| Max. Negotiated Rate |
$42.89 |
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Health Management Network Commercial |
$37.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.80
|
| Rate for Payer: MDX Hawaii PPO |
$42.89
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
OP
|
$58.14
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.07 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: AlohaCare Medicaid |
$29.07
|
| Rate for Payer: AlohaCare Medicare |
$29.07
|
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Devoted Health Medicare |
$31.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.23
|
| Rate for Payer: Health Management Network Commercial |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.07
|
| Rate for Payer: MDX Hawaii PPO |
$56.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.07
|
| Rate for Payer: University Health Alliance Commercial |
$42.38
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
OP
|
$44.22
|
|
|
Service Code
|
NDC 00409420810
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.11 |
| Max. Negotiated Rate |
$42.89 |
| Rate for Payer: AlohaCare Medicaid |
$22.11
|
| Rate for Payer: AlohaCare Medicare |
$22.11
|
| Rate for Payer: Cash Price |
$28.74
|
| Rate for Payer: Devoted Health Medicare |
$24.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.01
|
| Rate for Payer: Health Management Network Commercial |
$37.59
|
| Rate for Payer: Humana Medicare |
$22.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.11
|
| Rate for Payer: MDX Hawaii PPO |
$42.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.11
|
| Rate for Payer: University Health Alliance Commercial |
$32.23
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
OP
|
$16.96
|
|
|
Service Code
|
NDC 00409904517
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: AlohaCare Medicaid |
$8.48
|
| Rate for Payer: AlohaCare Medicare |
$8.48
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Devoted Health Medicare |
$9.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.48
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.11
|
| Rate for Payer: Health Management Network Commercial |
$14.42
|
| Rate for Payer: Humana Medicare |
$8.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.48
|
| Rate for Payer: MDX Hawaii PPO |
$16.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.48
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.48
|
| Rate for Payer: University Health Alliance Commercial |
$12.36
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
IP
|
$32.88
|
|
|
Service Code
|
NDC 00409174929
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$31.89 |
| Rate for Payer: Cash Price |
$21.37
|
| Rate for Payer: Health Management Network Commercial |
$27.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$29.59
|
| Rate for Payer: MDX Hawaii PPO |
$31.89
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
IP
|
$58.14
|
|
|
Service Code
|
NDC 63323046237
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$56.40 |
| Rate for Payer: Cash Price |
$37.79
|
| Rate for Payer: Health Management Network Commercial |
$49.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.33
|
| Rate for Payer: MDX Hawaii PPO |
$56.40
|
|
|
bupivac-0.5%-EPI 1:200,000 (PF) vial 30 ml [HHSC]
|
Facility
|
IP
|
$16.96
|
|
|
Service Code
|
NDC 00409904517
|
| Hospital Charge Code |
2500126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.42 |
| Max. Negotiated Rate |
$16.45 |
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Health Management Network Commercial |
$14.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.26
|
| Rate for Payer: MDX Hawaii PPO |
$16.45
|
|
|
bupivacaine 0.25% (PF) vial 30 ml [HHSC]
|
Facility
|
IP
|
$13.27
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$12.87 |
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Health Management Network Commercial |
$9.83
|
| Rate for Payer: Health Management Network Commercial |
$11.28
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$8.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.94
|
| Rate for Payer: MDX Hawaii PPO |
$11.21
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$9.63
|
| Rate for Payer: MDX Hawaii PPO |
$12.87
|
|
|
bupivacaine 0.25% (PF) vial 30 ml [HHSC]
|
Facility
|
OP
|
$44.74
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: AlohaCare Medicaid |
$22.37
|
| Rate for Payer: AlohaCare Medicaid |
$4.96
|
| Rate for Payer: AlohaCare Medicaid |
$6.63
|
| Rate for Payer: AlohaCare Medicaid |
$5.78
|
| Rate for Payer: AlohaCare Medicare |
$5.78
|
| Rate for Payer: AlohaCare Medicare |
$6.63
|
| Rate for Payer: AlohaCare Medicare |
$22.37
|
| Rate for Payer: AlohaCare Medicare |
$4.96
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$8.63
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Cash Price |
$7.51
|
| Rate for Payer: Cash Price |
$6.45
|
| Rate for Payer: Devoted Health Medicare |
$7.30
|
| Rate for Payer: Devoted Health Medicare |
$24.61
|
| Rate for Payer: Devoted Health Medicare |
$6.36
|
| Rate for Payer: Devoted Health Medicare |
$5.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.63
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.96
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.43
|
| Rate for Payer: Health Management Network Commercial |
$8.44
|
| Rate for Payer: Health Management Network Commercial |
$11.28
|
| Rate for Payer: Health Management Network Commercial |
$9.83
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Humana Medicare |
$6.63
|
| Rate for Payer: Humana Medicare |
$5.78
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Humana Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$11.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.78
|
| Rate for Payer: MDX Hawaii PPO |
$9.63
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$12.87
|
| Rate for Payer: MDX Hawaii PPO |
$11.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.78
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.84
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.96
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.78
|
| Rate for Payer: University Health Alliance Commercial |
$7.24
|
| Rate for Payer: University Health Alliance Commercial |
$32.61
|
| Rate for Payer: University Health Alliance Commercial |
$8.43
|
| Rate for Payer: University Health Alliance Commercial |
$9.67
|
|
|
bupivacaine 0.5% (PF) vial 30 ml [HHSC]
|
Facility
|
OP
|
$12.14
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$11.78 |
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: AlohaCare Medicaid |
$6.07
|
| Rate for Payer: AlohaCare Medicaid |
$26.02
|
| Rate for Payer: AlohaCare Medicaid |
$9.84
|
| Rate for Payer: AlohaCare Medicare |
$9.84
|
| Rate for Payer: AlohaCare Medicare |
$6.07
|
| Rate for Payer: AlohaCare Medicare |
$26.02
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Devoted Health Medicare |
$6.68
|
| Rate for Payer: Devoted Health Medicare |
$28.63
|
| Rate for Payer: Devoted Health Medicare |
$10.82
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.45
|
| Rate for Payer: Health Management Network Commercial |
$44.24
|
| Rate for Payer: Health Management Network Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$16.73
|
| Rate for Payer: Humana Medicare |
$6.07
|
| Rate for Payer: Humana Medicare |
$9.84
|
| Rate for Payer: Humana Medicare |
$26.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.84
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.02
|
| Rate for Payer: MDX Hawaii PPO |
$50.49
|
| Rate for Payer: MDX Hawaii PPO |
$19.09
|
| Rate for Payer: MDX Hawaii PPO |
$11.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.02
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.02
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.28
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.02
|
| Rate for Payer: University Health Alliance Commercial |
$8.85
|
| Rate for Payer: University Health Alliance Commercial |
$14.34
|
| Rate for Payer: University Health Alliance Commercial |
$37.94
|
|
|
bupivacaine 0.5% (PF) vial 30 ml [HHSC]
|
Facility
|
IP
|
$52.05
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.24 |
| Max. Negotiated Rate |
$50.49 |
| Rate for Payer: Cash Price |
$33.83
|
| Rate for Payer: Cash Price |
$12.79
|
| Rate for Payer: Cash Price |
$7.89
|
| Rate for Payer: Health Management Network Commercial |
$10.32
|
| Rate for Payer: Health Management Network Commercial |
$44.24
|
| Rate for Payer: Health Management Network Commercial |
$16.73
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.84
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.93
|
| Rate for Payer: MDX Hawaii PPO |
$19.09
|
| Rate for Payer: MDX Hawaii PPO |
$11.78
|
| Rate for Payer: MDX Hawaii PPO |
$50.49
|
|
|
bupivacaine 0.75% (PF) vial 10 ml [HHSC]
|
Facility
|
OP
|
$16.68
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500124
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: AlohaCare Medicaid |
$8.34
|
| Rate for Payer: AlohaCare Medicaid |
$15.85
|
| Rate for Payer: AlohaCare Medicaid |
$9.95
|
| Rate for Payer: AlohaCare Medicare |
$9.95
|
| Rate for Payer: AlohaCare Medicare |
$8.34
|
| Rate for Payer: AlohaCare Medicare |
$15.85
|
| Rate for Payer: Cash Price |
$12.93
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cash Price |
$12.93
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Devoted Health Medicare |
$9.17
|
| Rate for Payer: Devoted Health Medicare |
$17.43
|
| Rate for Payer: Devoted Health Medicare |
$10.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$15.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network Commercial |
$26.94
|
| Rate for Payer: Health Management Network Commercial |
$14.18
|
| Rate for Payer: Health Management Network Commercial |
$16.91
|
| Rate for Payer: Humana Medicare |
$8.34
|
| Rate for Payer: Humana Medicare |
$9.95
|
| Rate for Payer: Humana Medicare |
$15.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$15.85
|
| Rate for Payer: MDX Hawaii PPO |
$30.74
|
| Rate for Payer: MDX Hawaii PPO |
$19.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$15.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$15.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$15.85
|
| Rate for Payer: University Health Alliance Commercial |
$12.16
|
| Rate for Payer: University Health Alliance Commercial |
$14.51
|
| Rate for Payer: University Health Alliance Commercial |
$23.10
|
|
|
bupivacaine 0.75% (PF) vial 10 ml [HHSC]
|
Facility
|
IP
|
$31.69
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500124
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.94 |
| Max. Negotiated Rate |
$30.74 |
| Rate for Payer: Cash Price |
$20.60
|
| Rate for Payer: Cash Price |
$12.93
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Health Management Network Commercial |
$14.18
|
| Rate for Payer: Health Management Network Commercial |
$26.94
|
| Rate for Payer: Health Management Network Commercial |
$16.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.01
|
| Rate for Payer: MDX Hawaii PPO |
$19.30
|
| Rate for Payer: MDX Hawaii PPO |
$16.18
|
| Rate for Payer: MDX Hawaii PPO |
$30.74
|
|
|
bupivacaine-dextr 0.75% (PF) intrathecal 2 ml [HHSC]
|
Facility
|
OP
|
$16.65
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500123
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: AlohaCare Medicaid |
$8.32
|
| Rate for Payer: AlohaCare Medicaid |
$20.86
|
| Rate for Payer: AlohaCare Medicare |
$20.86
|
| Rate for Payer: AlohaCare Medicare |
$8.32
|
| Rate for Payer: Cash Price |
$27.12
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Cash Price |
$27.12
|
| Rate for Payer: Devoted Health Medicare |
$9.16
|
| Rate for Payer: Devoted Health Medicare |
$22.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.32
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.64
|
| Rate for Payer: Health Management Network Commercial |
$35.47
|
| Rate for Payer: Health Management Network Commercial |
$14.15
|
| Rate for Payer: Humana Medicare |
$8.32
|
| Rate for Payer: Humana Medicare |
$20.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.86
|
| Rate for Payer: MDX Hawaii PPO |
$16.15
|
| Rate for Payer: MDX Hawaii PPO |
$40.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.86
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.86
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.86
|
| Rate for Payer: University Health Alliance Commercial |
$12.14
|
| Rate for Payer: University Health Alliance Commercial |
$30.42
|
|
|
bupivacaine-dextr 0.75% (PF) intrathecal 2 ml [HHSC]
|
Facility
|
IP
|
$16.65
|
|
|
Service Code
|
HCPCS J0665
|
| Hospital Charge Code |
2500123
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.15 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Cash Price |
$10.82
|
| Rate for Payer: Cash Price |
$27.12
|
| Rate for Payer: Health Management Network Commercial |
$14.15
|
| Rate for Payer: Health Management Network Commercial |
$35.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.56
|
| Rate for Payer: MDX Hawaii PPO |
$40.48
|
| Rate for Payer: MDX Hawaii PPO |
$16.15
|
|
|
buprenorphine SL 2 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
2501037
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicaid |
$6.81
|
| Rate for Payer: AlohaCare Medicare |
$6.81
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Devoted Health Medicare |
$7.49
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Health Management Network Commercial |
$11.58
|
| Rate for Payer: Humana Medicare |
$6.81
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.81
|
| Rate for Payer: MDX Hawaii PPO |
$13.21
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
| Rate for Payer: University Health Alliance Commercial |
$9.93
|
|
|
buprenorphine SL 2 mg tablet [HHSC]
|
Facility
|
IP
|
$13.62
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
2501037
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.58 |
| Max. Negotiated Rate |
$13.21 |
| Rate for Payer: Cash Price |
$8.85
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$11.58
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$12.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: MDX Hawaii PPO |
$13.21
|
|
|
buprenorphine SL 8 mg tablet [HHSC]
|
Facility
|
OP
|
$23.35
|
|
|
Service Code
|
HCPCS J0571
|
| Hospital Charge Code |
2500127
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.68 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: AlohaCare Medicaid |
$11.68
|
| Rate for Payer: AlohaCare Medicaid |
$25.44
|
| Rate for Payer: AlohaCare Medicaid |
$8.06
|
| Rate for Payer: AlohaCare Medicaid |
$25.10
|
| Rate for Payer: AlohaCare Medicare |
$11.68
|
| Rate for Payer: AlohaCare Medicare |
$25.10
|
| Rate for Payer: AlohaCare Medicare |
$25.44
|
| Rate for Payer: AlohaCare Medicare |
$8.06
|
| Rate for Payer: Cash Price |
$15.18
|
| Rate for Payer: Cash Price |
$32.63
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Devoted Health Medicare |
$27.98
|
| Rate for Payer: Devoted Health Medicare |
$27.61
|
| Rate for Payer: Devoted Health Medicare |
$8.87
|
| Rate for Payer: Devoted Health Medicare |
$12.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.10
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.31
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.34
|
| Rate for Payer: Health Management Network Commercial |
$13.70
|
| Rate for Payer: Health Management Network Commercial |
$19.85
|
| Rate for Payer: Health Management Network Commercial |
$43.25
|
| Rate for Payer: Health Management Network Commercial |
$42.67
|
| Rate for Payer: Humana Medicare |
$25.44
|
| Rate for Payer: Humana Medicare |
$25.10
|
| Rate for Payer: Humana Medicare |
$8.06
|
| Rate for Payer: Humana Medicare |
$11.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.44
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.06
|
| Rate for Payer: MDX Hawaii PPO |
$15.64
|
| Rate for Payer: MDX Hawaii PPO |
$22.65
|
| Rate for Payer: MDX Hawaii PPO |
$49.35
|
| Rate for Payer: MDX Hawaii PPO |
$48.69
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.44
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.44
|
| Rate for Payer: University Health Alliance Commercial |
$11.75
|
| Rate for Payer: University Health Alliance Commercial |
$17.02
|
| Rate for Payer: University Health Alliance Commercial |
$36.59
|
| Rate for Payer: University Health Alliance Commercial |
$37.09
|
|
