|
ceFAZolin 3 gm vial [HHSC]
|
Facility
|
IP
|
$44.16
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
2501133
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.54 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Health Management Network Commercial |
$37.54
|
| Rate for Payer: Health Management Network Commercial |
$51.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.86
|
| Rate for Payer: MDX Hawaii PPO |
$59.13
|
| Rate for Payer: MDX Hawaii PPO |
$42.84
|
|
|
ceFAZolin 3 gm vial [HHSC]
|
Facility
|
OP
|
$44.16
|
|
|
Service Code
|
HCPCS J0688
|
| Hospital Charge Code |
2501133
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$42.84 |
| Rate for Payer: AlohaCare Medicaid |
$22.08
|
| Rate for Payer: AlohaCare Medicaid |
$30.48
|
| Rate for Payer: AlohaCare Medicare |
$30.48
|
| Rate for Payer: AlohaCare Medicare |
$22.08
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$28.70
|
| Rate for Payer: Cash Price |
$39.62
|
| Rate for Payer: Devoted Health Medicare |
$24.29
|
| Rate for Payer: Devoted Health Medicare |
$33.53
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.91
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$30.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.08
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.91
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$57.91
|
| Rate for Payer: Health Management Network Commercial |
$51.82
|
| Rate for Payer: Health Management Network Commercial |
$37.54
|
| Rate for Payer: Humana Medicare |
$22.08
|
| Rate for Payer: Humana Medicare |
$30.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$54.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$30.48
|
| Rate for Payer: MDX Hawaii PPO |
$42.84
|
| Rate for Payer: MDX Hawaii PPO |
$59.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$30.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$30.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$30.48
|
| Rate for Payer: University Health Alliance Commercial |
$32.19
|
| Rate for Payer: University Health Alliance Commercial |
$44.43
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
IP
|
$570.86
|
|
|
Service Code
|
NDC 65862021901
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$485.23 |
| Max. Negotiated Rate |
$553.73 |
| Rate for Payer: Cash Price |
$371.06
|
| Rate for Payer: Health Management Network Commercial |
$485.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.77
|
| Rate for Payer: MDX Hawaii PPO |
$553.73
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
OP
|
$571.09
|
|
|
Service Code
|
NDC 67877054888
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$285.55 |
| Max. Negotiated Rate |
$553.96 |
| Rate for Payer: AlohaCare Medicaid |
$285.55
|
| Rate for Payer: AlohaCare Medicare |
$285.55
|
| Rate for Payer: Cash Price |
$371.21
|
| Rate for Payer: Devoted Health Medicare |
$314.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$285.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.54
|
| Rate for Payer: Health Management Network Commercial |
$485.43
|
| Rate for Payer: Humana Medicare |
$285.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.98
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.55
|
| Rate for Payer: MDX Hawaii PPO |
$553.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$285.55
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$285.55
|
| Rate for Payer: University Health Alliance Commercial |
$416.27
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
IP
|
$571.09
|
|
|
Service Code
|
NDC 67877054888
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$485.43 |
| Max. Negotiated Rate |
$553.96 |
| Rate for Payer: Cash Price |
$371.21
|
| Rate for Payer: Health Management Network Commercial |
$485.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.98
|
| Rate for Payer: MDX Hawaii PPO |
$553.96
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
OP
|
$570.86
|
|
|
Service Code
|
NDC 65862021901
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$285.43 |
| Max. Negotiated Rate |
$553.73 |
| Rate for Payer: AlohaCare Medicaid |
$285.43
|
| Rate for Payer: AlohaCare Medicare |
$285.43
|
| Rate for Payer: Cash Price |
$371.06
|
| Rate for Payer: Devoted Health Medicare |
$313.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$285.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.32
|
| Rate for Payer: Health Management Network Commercial |
$485.23
|
| Rate for Payer: Humana Medicare |
$285.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$513.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.43
|
| Rate for Payer: MDX Hawaii PPO |
$553.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$285.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$285.43
|
| Rate for Payer: University Health Alliance Commercial |
$416.10
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
OP
|
$571.26
|
|
|
Service Code
|
NDC 68180072310
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$285.63 |
| Max. Negotiated Rate |
$554.12 |
| Rate for Payer: AlohaCare Medicaid |
$285.63
|
| Rate for Payer: AlohaCare Medicare |
$285.63
|
| Rate for Payer: Cash Price |
$371.32
|
| Rate for Payer: Devoted Health Medicare |
$314.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$285.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.70
|
| Rate for Payer: Health Management Network Commercial |
$485.57
|
| Rate for Payer: Humana Medicare |
$285.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.63
|
| Rate for Payer: MDX Hawaii PPO |
$554.12
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$285.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$285.63
|
| Rate for Payer: University Health Alliance Commercial |
$416.39
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
OP
|
$571.28
|
|
|
Service Code
|
NDC 00093413773
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$285.64 |
| Max. Negotiated Rate |
$554.14 |
| Rate for Payer: AlohaCare Medicaid |
$285.64
|
| Rate for Payer: AlohaCare Medicare |
$285.64
|
| Rate for Payer: Cash Price |
$371.33
|
| Rate for Payer: Devoted Health Medicare |
$314.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$285.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$542.72
|
| Rate for Payer: Health Management Network Commercial |
$485.59
|
| Rate for Payer: Humana Medicare |
$285.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$291.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$285.64
|
| Rate for Payer: MDX Hawaii PPO |
$554.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$285.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$285.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$342.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$285.64
|
| Rate for Payer: University Health Alliance Commercial |
$416.41
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
IP
|
$571.26
|
|
|
Service Code
|
NDC 68180072310
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$485.57 |
| Max. Negotiated Rate |
$554.12 |
| Rate for Payer: Cash Price |
$371.32
|
| Rate for Payer: Health Management Network Commercial |
$485.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.13
|
| Rate for Payer: MDX Hawaii PPO |
$554.12
|
|
|
cefdinir 250 mg/5 mL 100ml [HHSC]
|
Facility
|
IP
|
$571.28
|
|
|
Service Code
|
NDC 00093413773
|
| Hospital Charge Code |
2500152
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$485.59 |
| Max. Negotiated Rate |
$554.14 |
| Rate for Payer: Cash Price |
$371.33
|
| Rate for Payer: Health Management Network Commercial |
$485.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$514.15
|
| Rate for Payer: MDX Hawaii PPO |
$554.14
|
|
|
cefepime 1000mg vial [HHSC]
|
Facility
|
OP
|
$16.68
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
2500153
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.19 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: AlohaCare Medicaid |
$8.34
|
| Rate for Payer: AlohaCare Medicaid |
$20.32
|
| Rate for Payer: AlohaCare Medicaid |
$51.56
|
| Rate for Payer: AlohaCare Medicaid |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$21.50
|
| Rate for Payer: AlohaCare Medicare |
$51.56
|
| Rate for Payer: AlohaCare Medicare |
$8.34
|
| Rate for Payer: AlohaCare Medicare |
$20.32
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cash Price |
$67.03
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$67.03
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Devoted Health Medicare |
$22.36
|
| Rate for Payer: Devoted Health Medicare |
$9.17
|
| Rate for Payer: Devoted Health Medicare |
$23.64
|
| Rate for Payer: Devoted Health Medicare |
$56.72
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.34
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.19
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$97.97
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.85
|
| Rate for Payer: Health Management Network Commercial |
$34.55
|
| Rate for Payer: Health Management Network Commercial |
$87.66
|
| Rate for Payer: Health Management Network Commercial |
$14.18
|
| Rate for Payer: Health Management Network Commercial |
$36.54
|
| Rate for Payer: Humana Medicare |
$51.56
|
| Rate for Payer: Humana Medicare |
$20.32
|
| Rate for Payer: Humana Medicare |
$8.34
|
| Rate for Payer: Humana Medicare |
$21.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.69
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.51
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.34
|
| Rate for Payer: MDX Hawaii PPO |
$39.43
|
| Rate for Payer: MDX Hawaii PPO |
$100.04
|
| Rate for Payer: MDX Hawaii PPO |
$41.70
|
| Rate for Payer: MDX Hawaii PPO |
$16.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$61.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.34
|
| Rate for Payer: University Health Alliance Commercial |
$75.17
|
| Rate for Payer: University Health Alliance Commercial |
$12.16
|
| Rate for Payer: University Health Alliance Commercial |
$29.63
|
| Rate for Payer: University Health Alliance Commercial |
$31.34
|
|
|
cefepime 1000mg vial [HHSC]
|
Facility
|
IP
|
$16.68
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
2500153
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$16.18 |
| Rate for Payer: Cash Price |
$10.84
|
| Rate for Payer: Cash Price |
$27.94
|
| Rate for Payer: Cash Price |
$67.03
|
| Rate for Payer: Cash Price |
$26.42
|
| Rate for Payer: Health Management Network Commercial |
$87.66
|
| Rate for Payer: Health Management Network Commercial |
$36.54
|
| Rate for Payer: Health Management Network Commercial |
$14.18
|
| Rate for Payer: Health Management Network Commercial |
$34.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$15.01
|
| Rate for Payer: MDX Hawaii PPO |
$41.70
|
| Rate for Payer: MDX Hawaii PPO |
$100.04
|
| Rate for Payer: MDX Hawaii PPO |
$16.18
|
| Rate for Payer: MDX Hawaii PPO |
$39.43
|
|
|
cefepime 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$167.88
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
2500155
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: AlohaCare Medicaid |
$83.94
|
| Rate for Payer: AlohaCare Medicare |
$83.94
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Devoted Health Medicare |
$92.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$83.94
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$5.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.49
|
| Rate for Payer: Health Management Network Commercial |
$142.70
|
| Rate for Payer: Humana Medicare |
$83.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.62
|
| Rate for Payer: Kaiser Permanente Medicare |
$83.94
|
| Rate for Payer: MDX Hawaii PPO |
$162.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$83.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$83.94
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$83.94
|
| Rate for Payer: University Health Alliance Commercial |
$122.37
|
|
|
cefepime 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$167.88
|
|
|
Service Code
|
HCPCS J0703
|
| Hospital Charge Code |
2500155
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.70 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Cash Price |
$109.12
|
| Rate for Payer: Health Management Network Commercial |
$142.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.09
|
| Rate for Payer: MDX Hawaii PPO |
$162.84
|
|
|
cefpodoxime 200 mg tablet [HHSC]
|
Facility
|
OP
|
$50.72
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501098
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$49.20 |
| Rate for Payer: AlohaCare Medicaid |
$25.36
|
| Rate for Payer: AlohaCare Medicaid |
$25.43
|
| Rate for Payer: AlohaCare Medicare |
$25.36
|
| Rate for Payer: AlohaCare Medicare |
$25.43
|
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Devoted Health Medicare |
$27.90
|
| Rate for Payer: Devoted Health Medicare |
$27.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.33
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.18
|
| Rate for Payer: Health Management Network Commercial |
$43.11
|
| Rate for Payer: Health Management Network Commercial |
$43.24
|
| Rate for Payer: Humana Medicare |
$25.43
|
| Rate for Payer: Humana Medicare |
$25.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.78
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.36
|
| Rate for Payer: MDX Hawaii PPO |
$49.34
|
| Rate for Payer: MDX Hawaii PPO |
$49.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.43
|
| Rate for Payer: University Health Alliance Commercial |
$37.08
|
| Rate for Payer: University Health Alliance Commercial |
$36.97
|
|
|
cefpodoxime 200 mg tablet [HHSC]
|
Facility
|
IP
|
$50.87
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501098
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.24 |
| Max. Negotiated Rate |
$49.34 |
| Rate for Payer: Cash Price |
$33.07
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Health Management Network Commercial |
$43.24
|
| Rate for Payer: Health Management Network Commercial |
$43.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.65
|
| Rate for Payer: MDX Hawaii PPO |
$49.20
|
| Rate for Payer: MDX Hawaii PPO |
$49.34
|
|
|
cefTRIAXone 1000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$116.86
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500160
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.33 |
| Max. Negotiated Rate |
$113.35 |
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Health Management Network Commercial |
$99.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.17
|
| Rate for Payer: MDX Hawaii PPO |
$113.35
|
|
|
cefTRIAXone 1000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$116.86
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500160
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$113.35 |
| Rate for Payer: AlohaCare Medicaid |
$58.43
|
| Rate for Payer: AlohaCare Medicare |
$58.43
|
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Cash Price |
$75.96
|
| Rate for Payer: Devoted Health Medicare |
$64.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.43
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.02
|
| Rate for Payer: Health Management Network Commercial |
$99.33
|
| Rate for Payer: Humana Medicare |
$58.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.43
|
| Rate for Payer: MDX Hawaii PPO |
$113.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.12
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.43
|
| Rate for Payer: University Health Alliance Commercial |
$85.18
|
|
|
cefTRIAXone 1000mg vial [HHSC]
|
Facility
|
OP
|
$16.01
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500159
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.01 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: AlohaCare Medicaid |
$8.01
|
| Rate for Payer: AlohaCare Medicaid |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$5.00
|
| Rate for Payer: AlohaCare Medicare |
$8.01
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Devoted Health Medicare |
$5.51
|
| Rate for Payer: Devoted Health Medicare |
$8.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.21
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Health Management Network Commercial |
$13.61
|
| Rate for Payer: Humana Medicare |
$5.00
|
| Rate for Payer: Humana Medicare |
$8.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.01
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: MDX Hawaii PPO |
$15.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.01
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.01
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.00
|
| Rate for Payer: University Health Alliance Commercial |
$7.30
|
| Rate for Payer: University Health Alliance Commercial |
$11.67
|
|
|
cefTRIAXone 1000mg vial [HHSC]
|
Facility
|
IP
|
$10.01
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500159
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Cash Price |
$6.51
|
| Rate for Payer: Cash Price |
$10.41
|
| Rate for Payer: Health Management Network Commercial |
$13.61
|
| Rate for Payer: Health Management Network Commercial |
$8.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.41
|
| Rate for Payer: MDX Hawaii PPO |
$9.71
|
| Rate for Payer: MDX Hawaii PPO |
$15.53
|
|
|
cefTRIAXone 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
OP
|
$149.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: AlohaCare Medicaid |
$74.89
|
| Rate for Payer: AlohaCare Medicare |
$74.89
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Devoted Health Medicare |
$82.37
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$142.28
|
| Rate for Payer: Health Management Network Commercial |
$127.30
|
| Rate for Payer: Humana Medicare |
$74.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$76.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.89
|
| Rate for Payer: MDX Hawaii PPO |
$145.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.89
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$89.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.89
|
| Rate for Payer: University Health Alliance Commercial |
$109.17
|
|
|
cefTRIAXone 2000mg/50mL-D5W premix [HHSC]
|
Facility
|
IP
|
$149.77
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$127.30 |
| Max. Negotiated Rate |
$145.28 |
| Rate for Payer: Cash Price |
$97.35
|
| Rate for Payer: Health Management Network Commercial |
$127.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$134.79
|
| Rate for Payer: MDX Hawaii PPO |
$145.28
|
|
|
cefTRIAXone 2 gm vial [HHSC]
|
Facility
|
IP
|
$19.02
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500161
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$18.45 |
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Health Management Network Commercial |
$16.30
|
| Rate for Payer: Health Management Network Commercial |
$16.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.26
|
| Rate for Payer: MDX Hawaii PPO |
$18.45
|
| Rate for Payer: MDX Hawaii PPO |
$18.60
|
|
|
cefTRIAXone 2 gm vial [HHSC]
|
Facility
|
OP
|
$19.18
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500161
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$18.60 |
| Rate for Payer: AlohaCare Medicaid |
$9.59
|
| Rate for Payer: AlohaCare Medicaid |
$9.51
|
| Rate for Payer: AlohaCare Medicare |
$9.51
|
| Rate for Payer: AlohaCare Medicare |
$9.59
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Cash Price |
$12.47
|
| Rate for Payer: Devoted Health Medicare |
$10.46
|
| Rate for Payer: Devoted Health Medicare |
$10.55
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.59
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.22
|
| Rate for Payer: Health Management Network Commercial |
$16.17
|
| Rate for Payer: Health Management Network Commercial |
$16.30
|
| Rate for Payer: Humana Medicare |
$9.51
|
| Rate for Payer: Humana Medicare |
$9.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.59
|
| Rate for Payer: MDX Hawaii PPO |
$18.45
|
| Rate for Payer: MDX Hawaii PPO |
$18.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.51
|
| Rate for Payer: University Health Alliance Commercial |
$13.86
|
| Rate for Payer: University Health Alliance Commercial |
$13.98
|
|
|
cefTRIAXone 500 mg vial [HHSC]
|
Facility
|
OP
|
$7.67
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2500163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$9.70 |
| Rate for Payer: AlohaCare Medicaid |
$3.83
|
| Rate for Payer: AlohaCare Medicaid |
$3.17
|
| Rate for Payer: AlohaCare Medicare |
$3.17
|
| Rate for Payer: AlohaCare Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.12
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Cash Price |
$4.99
|
| Rate for Payer: Devoted Health Medicare |
$3.49
|
| Rate for Payer: Devoted Health Medicare |
$4.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.29
|
| Rate for Payer: Health Management Network Commercial |
$5.39
|
| Rate for Payer: Health Management Network Commercial |
$6.52
|
| Rate for Payer: Humana Medicare |
$3.17
|
| Rate for Payer: Humana Medicare |
$3.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.83
|
| Rate for Payer: MDX Hawaii PPO |
$6.15
|
| Rate for Payer: MDX Hawaii PPO |
$7.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$3.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$4.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.17
|
| Rate for Payer: University Health Alliance Commercial |
$4.62
|
| Rate for Payer: University Health Alliance Commercial |
$5.59
|
|
