|
cloNIDine 0.1 mg/24 hr patch [HHSC]
|
Facility
|
IP
|
$156.60
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
2500193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.11 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: Cash Price |
$101.79
|
| Rate for Payer: Health Management Network Commercial |
$133.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.94
|
| Rate for Payer: MDX Hawaii PPO |
$151.90
|
|
|
cloNIDine 0.1 mg/24 hr patch [HHSC]
|
Facility
|
OP
|
$156.75
|
|
|
Service Code
|
NDC 51862045304
|
| Hospital Charge Code |
2500193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$152.05 |
| Rate for Payer: AlohaCare Medicaid |
$78.38
|
| Rate for Payer: AlohaCare Medicare |
$78.38
|
| Rate for Payer: Cash Price |
$101.89
|
| Rate for Payer: Devoted Health Medicare |
$86.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.91
|
| Rate for Payer: Health Management Network Commercial |
$133.24
|
| Rate for Payer: Humana Medicare |
$78.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.38
|
| Rate for Payer: MDX Hawaii PPO |
$152.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.38
|
| Rate for Payer: University Health Alliance Commercial |
$114.26
|
|
|
cloNIDine 0.1 mg/24 hr patch [HHSC]
|
Facility
|
OP
|
$156.75
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
2500193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.38 |
| Max. Negotiated Rate |
$152.05 |
| Rate for Payer: AlohaCare Medicaid |
$78.38
|
| Rate for Payer: AlohaCare Medicare |
$78.38
|
| Rate for Payer: Cash Price |
$101.89
|
| Rate for Payer: Devoted Health Medicare |
$86.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.91
|
| Rate for Payer: Health Management Network Commercial |
$133.24
|
| Rate for Payer: Humana Medicare |
$78.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.38
|
| Rate for Payer: MDX Hawaii PPO |
$152.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.38
|
| Rate for Payer: UnitedHealthcare Medicaid |
$94.05
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.38
|
| Rate for Payer: University Health Alliance Commercial |
$114.26
|
|
|
cloNIDine 0.1 mg/24 hr patch [HHSC]
|
Facility
|
IP
|
$156.75
|
|
|
Service Code
|
NDC 75907002348
|
| Hospital Charge Code |
2500193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.24 |
| Max. Negotiated Rate |
$152.05 |
| Rate for Payer: Cash Price |
$101.89
|
| Rate for Payer: Health Management Network Commercial |
$133.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.07
|
| Rate for Payer: MDX Hawaii PPO |
$152.05
|
|
|
cloNIDine 0.1 mg/24 hr patch [HHSC]
|
Facility
|
IP
|
$156.75
|
|
|
Service Code
|
NDC 51862045304
|
| Hospital Charge Code |
2500193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.24 |
| Max. Negotiated Rate |
$152.05 |
| Rate for Payer: Cash Price |
$101.89
|
| Rate for Payer: Health Management Network Commercial |
$133.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.07
|
| Rate for Payer: MDX Hawaii PPO |
$152.05
|
|
|
cloNIDine 0.1 mg/24 hr patch [HHSC]
|
Facility
|
OP
|
$156.60
|
|
|
Service Code
|
NDC 00591350804
|
| Hospital Charge Code |
2500193
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.30 |
| Max. Negotiated Rate |
$151.90 |
| Rate for Payer: AlohaCare Medicaid |
$78.30
|
| Rate for Payer: AlohaCare Medicare |
$78.30
|
| Rate for Payer: Cash Price |
$101.79
|
| Rate for Payer: Devoted Health Medicare |
$86.13
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$148.77
|
| Rate for Payer: Health Management Network Commercial |
$133.11
|
| Rate for Payer: Humana Medicare |
$78.30
|
| Rate for Payer: Kaiser Permanente Commercial |
$140.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$79.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.30
|
| Rate for Payer: MDX Hawaii PPO |
$151.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.30
|
| Rate for Payer: UnitedHealthcare Medicaid |
$93.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.30
|
| Rate for Payer: University Health Alliance Commercial |
$114.15
|
|
|
cloNIDine 0.1 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
2500192
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$17.67 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.67
|
| 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
|
|
|
cloNIDine 0.1 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS J0735
|
| Hospital Charge Code |
2500192
|
|
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
|
|
|
cloNIDine 0.2 mg/24 hr patch [HHSC]
|
Facility
|
IP
|
$294.71
|
|
|
Service Code
|
NDC 75907002448
|
| Hospital Charge Code |
2500194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.50 |
| Max. Negotiated Rate |
$285.87 |
| Rate for Payer: Cash Price |
$191.56
|
| Rate for Payer: Health Management Network Commercial |
$250.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.24
|
| Rate for Payer: MDX Hawaii PPO |
$285.87
|
|
|
cloNIDine 0.2 mg/24 hr patch [HHSC]
|
Facility
|
OP
|
$294.71
|
|
|
Service Code
|
NDC 75907002448
|
| Hospital Charge Code |
2500194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$285.87 |
| Rate for Payer: AlohaCare Medicaid |
$147.35
|
| Rate for Payer: AlohaCare Medicare |
$147.35
|
| Rate for Payer: Cash Price |
$191.56
|
| Rate for Payer: Devoted Health Medicare |
$162.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$279.97
|
| Rate for Payer: Health Management Network Commercial |
$250.50
|
| Rate for Payer: Humana Medicare |
$147.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.35
|
| Rate for Payer: MDX Hawaii PPO |
$285.87
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.35
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.35
|
| Rate for Payer: University Health Alliance Commercial |
$214.81
|
|
|
cloNIDine 0.2 mg/24 hr patch [HHSC]
|
Facility
|
IP
|
$297.49
|
|
|
Service Code
|
NDC 51862045404
|
| Hospital Charge Code |
2500194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$252.87 |
| Max. Negotiated Rate |
$288.57 |
| Rate for Payer: Cash Price |
$193.37
|
| Rate for Payer: Health Management Network Commercial |
$252.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.74
|
| Rate for Payer: MDX Hawaii PPO |
$288.57
|
|
|
cloNIDine 0.2 mg/24 hr patch [HHSC]
|
Facility
|
OP
|
$297.49
|
|
|
Service Code
|
NDC 51862045404
|
| Hospital Charge Code |
2500194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$148.75 |
| Max. Negotiated Rate |
$288.57 |
| Rate for Payer: AlohaCare Medicaid |
$148.75
|
| Rate for Payer: AlohaCare Medicare |
$148.75
|
| Rate for Payer: Cash Price |
$193.37
|
| Rate for Payer: Devoted Health Medicare |
$163.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$282.62
|
| Rate for Payer: Health Management Network Commercial |
$252.87
|
| Rate for Payer: Humana Medicare |
$148.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.75
|
| Rate for Payer: MDX Hawaii PPO |
$288.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$178.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.75
|
| Rate for Payer: University Health Alliance Commercial |
$216.84
|
|
|
cloNIDine 0.2 mg/24 hr patch [HHSC]
|
Facility
|
IP
|
$294.49
|
|
|
Service Code
|
NDC 00591350904
|
| Hospital Charge Code |
2500194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$250.32 |
| Max. Negotiated Rate |
$285.66 |
| Rate for Payer: Cash Price |
$191.42
|
| Rate for Payer: Health Management Network Commercial |
$250.32
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.04
|
| Rate for Payer: MDX Hawaii PPO |
$285.66
|
|
|
cloNIDine 0.2 mg/24 hr patch [HHSC]
|
Facility
|
OP
|
$294.49
|
|
|
Service Code
|
NDC 00591350904
|
| Hospital Charge Code |
2500194
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$147.25 |
| Max. Negotiated Rate |
$285.66 |
| Rate for Payer: AlohaCare Medicaid |
$147.25
|
| Rate for Payer: AlohaCare Medicare |
$147.25
|
| Rate for Payer: Cash Price |
$191.42
|
| Rate for Payer: Devoted Health Medicare |
$161.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$147.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$279.77
|
| Rate for Payer: Health Management Network Commercial |
$250.32
|
| Rate for Payer: Humana Medicare |
$147.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$265.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$150.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$147.25
|
| Rate for Payer: MDX Hawaii PPO |
$285.66
|
| Rate for Payer: Ohana Health Plan Medicaid |
$147.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$147.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$176.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$147.25
|
| Rate for Payer: University Health Alliance Commercial |
$214.65
|
|
|
clopidogrel 75 mg tablet [HHSC]
|
Facility
|
OP
|
$42.86
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
2500196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$41.57 |
| Rate for Payer: AlohaCare Medicaid |
$21.43
|
| Rate for Payer: AlohaCare Medicare |
$21.43
|
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Devoted Health Medicare |
$23.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.43
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.72
|
| Rate for Payer: Health Management Network Commercial |
$36.43
|
| Rate for Payer: Humana Medicare |
$21.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.43
|
| Rate for Payer: MDX Hawaii PPO |
$41.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.43
|
| Rate for Payer: University Health Alliance Commercial |
$31.24
|
|
|
clopidogrel 75 mg tablet [HHSC]
|
Facility
|
IP
|
$42.86
|
|
|
Service Code
|
NDC 68084053601
|
| Hospital Charge Code |
2500196
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$41.57 |
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Health Management Network Commercial |
$36.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.57
|
| Rate for Payer: MDX Hawaii PPO |
$41.57
|
|
|
Closed Elbow Dis W/o Anes TechFee
|
Facility
|
IP
|
$823.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
8022932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$699.55 |
| Max. Negotiated Rate |
$798.31 |
| Rate for Payer: Cash Price |
$534.95
|
| Rate for Payer: Health Management Network Commercial |
$699.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.70
|
| Rate for Payer: MDX Hawaii PPO |
$798.31
|
|
|
Closed Elbow Dis W/o Anes TechFee
|
Facility
|
OP
|
$823.00
|
|
|
Service Code
|
HCPCS 24600
|
| Hospital Charge Code |
8022932
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$2,389.00 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$411.50
|
| Rate for Payer: Cash Price |
$534.95
|
| Rate for Payer: Cash Price |
$534.95
|
| Rate for Payer: Cash Price |
$534.95
|
| Rate for Payer: Devoted Health Medicare |
$452.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$393.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$2,389.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$411.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$781.85
|
| Rate for Payer: Health Management Network Commercial |
$699.55
|
| Rate for Payer: Humana Medicare |
$411.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$740.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$411.50
|
| Rate for Payer: MDX Hawaii PPO |
$798.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$411.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$411.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$411.50
|
| Rate for Payer: University Health Alliance Commercial |
$599.88
|
|
|
CLOSED TRACHEAL SUCTION CHARGE
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
8243409
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$72.25 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.50
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
|
|
CLOSED TRACHEAL SUCTION CHARGE
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
8243409
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$42.50 |
| Max. Negotiated Rate |
$82.45 |
| Rate for Payer: AlohaCare Medicaid |
$42.50
|
| Rate for Payer: AlohaCare Medicare |
$42.50
|
| Rate for Payer: Cash Price |
$55.25
|
| Rate for Payer: Devoted Health Medicare |
$46.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$80.75
|
| Rate for Payer: Health Management Network Commercial |
$72.25
|
| Rate for Payer: Humana Medicare |
$42.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.50
|
| Rate for Payer: MDX Hawaii PPO |
$82.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.50
|
| Rate for Payer: University Health Alliance Commercial |
$61.96
|
|
|
Clostridium Difficile Antigen/Toxin Antibody Reflex PCR FSI
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
8117884
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$147.05 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
|
|
Clostridium Difficile Antigen/Toxin Antibody Reflex PCR FSI
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
HCPCS 87324
|
| Hospital Charge Code |
8117884
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$167.81 |
| Rate for Payer: AlohaCare Medicaid |
$86.50
|
| Rate for Payer: AlohaCare Medicare |
$86.50
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Cash Price |
$112.45
|
| Rate for Payer: Devoted Health Medicare |
$95.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$147.05
|
| Rate for Payer: Humana Medicare |
$86.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$155.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$88.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.50
|
| Rate for Payer: MDX Hawaii PPO |
$167.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Clostridium Difficile PCR FSI
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
8117885
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: AlohaCare Medicaid |
$138.00
|
| Rate for Payer: AlohaCare Medicare |
$138.00
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Devoted Health Medicare |
$151.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.59
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$138.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network Commercial |
$234.60
|
| Rate for Payer: Humana Medicare |
$138.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$140.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$138.00
|
| Rate for Payer: MDX Hawaii PPO |
$267.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$138.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$138.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$138.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.04
|
|
|
Clostridium Difficile PCR FSI
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS 86160
|
| Hospital Charge Code |
8117885
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Health Management Network Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$248.40
|
| Rate for Payer: MDX Hawaii PPO |
$267.72
|
|
|
clotrimazole 1% cream topical [HHSC]
|
Facility
|
IP
|
$51.51
|
|
|
Service Code
|
NDC 45802043411
|
| Hospital Charge Code |
2500197
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.78 |
| Max. Negotiated Rate |
$49.96 |
| Rate for Payer: Cash Price |
$33.48
|
| Rate for Payer: Health Management Network Commercial |
$43.78
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.36
|
| Rate for Payer: MDX Hawaii PPO |
$49.96
|
|
