|
CAUTERY, HANDSWITCHING PENCIL
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
8274434
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Health Management Network Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$32.40
|
| Rate for Payer: MDX Hawaii PPO |
$34.92
|
|
|
CAUTERY INSULATED ELECTRODE SPATULA (MASTECTOMY)
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
8274151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.50 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: AlohaCare Medicaid |
$20.50
|
| Rate for Payer: AlohaCare Medicare |
$20.50
|
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Devoted Health Medicare |
$22.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.95
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Humana Medicare |
$20.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.50
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.50
|
| Rate for Payer: University Health Alliance Commercial |
$29.88
|
|
|
CAUTERY INSULATED ELECTRODE SPATULA (MASTECTOMY)
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
8274151
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.85 |
| Max. Negotiated Rate |
$39.77 |
| Rate for Payer: Cash Price |
$26.65
|
| Rate for Payer: Health Management Network Commercial |
$34.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.90
|
| Rate for Payer: MDX Hawaii PPO |
$39.77
|
|
|
CAUTERY INSULATED NEEDLE TIP
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
8274435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.65 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: Cash Price |
$18.85
|
| 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
|
|
|
CAUTERY INSULATED NEEDLE TIP
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
8274435
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$28.13 |
| Rate for Payer: AlohaCare Medicaid |
$14.50
|
| Rate for Payer: AlohaCare Medicare |
$14.50
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Devoted Health Medicare |
$15.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$27.55
|
| Rate for Payer: Health Management Network Commercial |
$24.65
|
| Rate for Payer: Humana Medicare |
$14.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$14.79
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.50
|
| Rate for Payer: MDX Hawaii PPO |
$28.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.50
|
| Rate for Payer: University Health Alliance Commercial |
$21.14
|
|
|
CBC Complete Blood Count w/ Diff FSI
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
8117875
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
|
|
CBC Complete Blood Count w/ Diff FSI
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
HCPCS 85025
|
| Hospital Charge Code |
8117875
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.77 |
| Max. Negotiated Rate |
$110.58 |
| Rate for Payer: AlohaCare Medicaid |
$57.00
|
| Rate for Payer: AlohaCare Medicare |
$57.00
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Cash Price |
$74.10
|
| Rate for Payer: Devoted Health Medicare |
$62.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$10.74
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$11.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.77
|
| Rate for Payer: Health Management Network Commercial |
$96.90
|
| Rate for Payer: Humana Medicare |
$57.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$102.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.00
|
| Rate for Payer: MDX Hawaii PPO |
$110.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.00
|
| Rate for Payer: University Health Alliance Commercial |
$20.09
|
|
|
CBC Complete Blood Count w/ Manual Diff FSI
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
8117876
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
CBC Complete Blood Count w/ Manual Diff FSI
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
8117876
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$48.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$52.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$48.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.00
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
CBC without Diff FSI
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
8117853
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: AlohaCare Medicaid |
$48.00
|
| Rate for Payer: AlohaCare Medicare |
$48.00
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Devoted Health Medicare |
$52.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.95
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.47
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Humana Medicare |
$48.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.00
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.00
|
| Rate for Payer: University Health Alliance Commercial |
$16.72
|
|
|
CBC without Diff FSI
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS 85027
|
| Hospital Charge Code |
8117853
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$93.12 |
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Health Management Network Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.40
|
| Rate for Payer: MDX Hawaii PPO |
$93.12
|
|
|
CBT 1ST HOUR CHARGE
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
8243382
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$27.58 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: AlohaCare Medicaid |
$187.50
|
| Rate for Payer: AlohaCare Medicare |
$187.50
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Devoted Health Medicare |
$206.25
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$169.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$356.25
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Humana Medicare |
$187.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$191.25
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.50
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.50
|
| Rate for Payer: University Health Alliance Commercial |
$273.34
|
|
|
CBT 1ST HOUR CHARGE
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
HCPCS 94644
|
| Hospital Charge Code |
8243382
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$318.75 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: Cash Price |
$243.75
|
| Rate for Payer: Health Management Network Commercial |
$318.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$337.50
|
| Rate for Payer: MDX Hawaii PPO |
$363.75
|
|
|
CBT EACH ADDL HOUR CHARGE
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
8243383
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$141.10 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
|
|
CBT EACH ADDL HOUR CHARGE
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
HCPCS 94645
|
| Hospital Charge Code |
8243383
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$161.02 |
| Rate for Payer: AlohaCare Medicaid |
$83.00
|
| Rate for Payer: AlohaCare Medicare |
$83.00
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Cash Price |
$107.90
|
| Rate for Payer: Devoted Health Medicare |
$91.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$157.70
|
| Rate for Payer: Health Management Network Commercial |
$141.10
|
| Rate for Payer: Humana Medicare |
$83.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$149.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$84.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.00
|
| Rate for Payer: MDX Hawaii PPO |
$161.02
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.00
|
| Rate for Payer: University Health Alliance Commercial |
$121.00
|
|
|
CEA Carcinoembrionic Antigen FSI
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
8117877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: AlohaCare Medicaid |
$108.00
|
| Rate for Payer: AlohaCare Medicare |
$108.00
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Devoted Health Medicare |
$118.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$26.22
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$108.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.96
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Humana Medicare |
$108.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$110.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$108.00
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$108.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$108.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.22
|
| Rate for Payer: UnitedHealthcare Medicare |
$108.00
|
| Rate for Payer: University Health Alliance Commercial |
$49.04
|
|
|
CEA Carcinoembrionic Antigen FSI
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
HCPCS 82378
|
| Hospital Charge Code |
8117877
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$209.52 |
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Health Management Network Commercial |
$183.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$194.40
|
| Rate for Payer: MDX Hawaii PPO |
$209.52
|
|
|
cefaz 150mg/ dex 6mg cmpd [HHSC]
|
Facility
|
IP
|
$29.95
|
|
|
Service Code
|
NDC 99999999910
|
| Hospital Charge Code |
2500986
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.46 |
| Max. Negotiated Rate |
$29.05 |
| Rate for Payer: Cash Price |
$19.47
|
| Rate for Payer: Health Management Network Commercial |
$25.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.95
|
| Rate for Payer: MDX Hawaii PPO |
$29.05
|
|
|
cefaz 150mg/ dex 6mg cmpd [HHSC]
|
Facility
|
OP
|
$29.95
|
|
|
Service Code
|
NDC 99999999910
|
| Hospital Charge Code |
2500986
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$29.05 |
| Rate for Payer: AlohaCare Medicaid |
$14.97
|
| Rate for Payer: AlohaCare Medicare |
$14.97
|
| Rate for Payer: Cash Price |
$19.47
|
| Rate for Payer: Devoted Health Medicare |
$16.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.45
|
| Rate for Payer: Health Management Network Commercial |
$25.46
|
| Rate for Payer: Humana Medicare |
$14.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.97
|
| Rate for Payer: MDX Hawaii PPO |
$29.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.97
|
| Rate for Payer: University Health Alliance Commercial |
$21.83
|
|
|
cefazolin 15 mg/heparin 7500 units/3 mL cmpd [HHSC]
|
Facility
|
OP
|
$62.38
|
|
|
Service Code
|
NDC 99999999969
|
| Hospital Charge Code |
2500989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.19 |
| Max. Negotiated Rate |
$60.51 |
| Rate for Payer: AlohaCare Medicaid |
$31.19
|
| Rate for Payer: AlohaCare Medicare |
$31.19
|
| Rate for Payer: Cash Price |
$40.55
|
| Rate for Payer: Devoted Health Medicare |
$34.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.26
|
| Rate for Payer: Health Management Network Commercial |
$53.02
|
| Rate for Payer: Humana Medicare |
$31.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.19
|
| Rate for Payer: MDX Hawaii PPO |
$60.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.19
|
| Rate for Payer: University Health Alliance Commercial |
$45.47
|
|
|
cefazolin 15 mg/heparin 7500 units/3 mL cmpd [HHSC]
|
Facility
|
IP
|
$62.38
|
|
|
Service Code
|
NDC 99999999969
|
| Hospital Charge Code |
2500989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$53.02 |
| Max. Negotiated Rate |
$60.51 |
| Rate for Payer: Cash Price |
$40.55
|
| Rate for Payer: Health Management Network Commercial |
$53.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.14
|
| Rate for Payer: MDX Hawaii PPO |
$60.51
|
|
|
ceFAZolin 1 gm vial [HHSC]
|
Facility
|
OP
|
$25.63
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$24.86 |
| Rate for Payer: AlohaCare Medicaid |
$12.81
|
| Rate for Payer: AlohaCare Medicaid |
$3.51
|
| Rate for Payer: AlohaCare Medicare |
$3.51
|
| Rate for Payer: AlohaCare Medicare |
$12.81
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Devoted Health Medicare |
$14.10
|
| Rate for Payer: Devoted Health Medicare |
$3.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$24.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.67
|
| Rate for Payer: Health Management Network Commercial |
$5.97
|
| Rate for Payer: Health Management Network Commercial |
$21.79
|
| Rate for Payer: Humana Medicare |
$12.81
|
| Rate for Payer: Humana Medicare |
$3.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.51
|
| Rate for Payer: MDX Hawaii PPO |
$24.86
|
| Rate for Payer: MDX Hawaii PPO |
$6.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$15.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.51
|
| Rate for Payer: University Health Alliance Commercial |
$18.68
|
| Rate for Payer: University Health Alliance Commercial |
$5.12
|
|
|
ceFAZolin 1 gm vial [HHSC]
|
Facility
|
IP
|
$25.63
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$24.86 |
| Rate for Payer: Cash Price |
$16.66
|
| Rate for Payer: Cash Price |
$4.56
|
| Rate for Payer: Health Management Network Commercial |
$21.79
|
| Rate for Payer: Health Management Network Commercial |
$5.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$23.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.32
|
| Rate for Payer: MDX Hawaii PPO |
$6.81
|
| Rate for Payer: MDX Hawaii PPO |
$24.86
|
|
|
ceFAZolin 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$92.19
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.36 |
| Max. Negotiated Rate |
$89.42 |
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Health Management Network Commercial |
$78.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.97
|
| Rate for Payer: MDX Hawaii PPO |
$89.42
|
|
|
ceFAZolin 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$92.19
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
2500151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$89.42 |
| Rate for Payer: AlohaCare Medicaid |
$46.09
|
| Rate for Payer: AlohaCare Medicare |
$46.09
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Cash Price |
$59.92
|
| Rate for Payer: Devoted Health Medicare |
$50.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.37
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.58
|
| Rate for Payer: Health Management Network Commercial |
$78.36
|
| Rate for Payer: Humana Medicare |
$46.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.97
|
| Rate for Payer: Kaiser Permanente Medicaid |
$47.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.09
|
| Rate for Payer: MDX Hawaii PPO |
$89.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.31
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.09
|
| Rate for Payer: University Health Alliance Commercial |
$67.20
|
|
