|
Culture, Pertussis FSI
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
8228906
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
Culture, Tissue w/ Sens (Outer Islands) FSI
|
Facility
|
IP
|
$127.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
8228925
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$107.95 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
|
|
Culture, Tissue w/ Sens (Outer Islands) FSI
|
Facility
|
OP
|
$127.00
|
|
|
Service Code
|
HCPCS 87070
|
| Hospital Charge Code |
8228925
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$123.19 |
| Rate for Payer: AlohaCare Medicaid |
$63.50
|
| Rate for Payer: AlohaCare Medicare |
$63.50
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Cash Price |
$82.55
|
| Rate for Payer: Devoted Health Medicare |
$69.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$12.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$8.62
|
| Rate for Payer: Health Management Network Commercial |
$107.95
|
| Rate for Payer: Humana Medicare |
$63.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$114.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.50
|
| Rate for Payer: MDX Hawaii PPO |
$123.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.50
|
| Rate for Payer: University Health Alliance Commercial |
$22.26
|
|
|
Culture Typing Chlamydia
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
9700507
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$75.65 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
|
|
Culture Typing Chlamydia
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS 97140
|
| Hospital Charge Code |
9700507
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.55 |
| Max. Negotiated Rate |
$86.33 |
| Rate for Payer: AlohaCare Medicaid |
$44.50
|
| Rate for Payer: AlohaCare Medicare |
$44.50
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Cash Price |
$57.85
|
| Rate for Payer: Devoted Health Medicare |
$48.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.55
|
| Rate for Payer: Health Management Network Commercial |
$75.65
|
| Rate for Payer: Humana Medicare |
$44.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.50
|
| Rate for Payer: MDX Hawaii PPO |
$86.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$20.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.50
|
| Rate for Payer: University Health Alliance Commercial |
$64.87
|
|
|
Culture, Varicella Zoster FSI
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
8228938
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$138.55 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
|
|
Culture, Varicella Zoster FSI
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
HCPCS 87254
|
| Hospital Charge Code |
8228938
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$158.11 |
| Rate for Payer: AlohaCare Medicaid |
$81.50
|
| Rate for Payer: AlohaCare Medicare |
$81.50
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Cash Price |
$105.95
|
| Rate for Payer: Devoted Health Medicare |
$89.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.39
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$24.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$81.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$26.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.56
|
| Rate for Payer: Health Management Network Commercial |
$138.55
|
| Rate for Payer: Humana Medicare |
$81.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$83.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$81.50
|
| Rate for Payer: MDX Hawaii PPO |
$158.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$81.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$81.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$81.50
|
| Rate for Payer: University Health Alliance Commercial |
$50.54
|
|
|
Culture, Viral, Non Respiratory FSI
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
8228939
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$252.45 |
| Max. Negotiated Rate |
$288.09 |
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
|
|
Culture, Viral, Non Respiratory FSI
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
8228939
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$288.09 |
| Rate for Payer: AlohaCare Medicaid |
$148.50
|
| Rate for Payer: AlohaCare Medicare |
$148.50
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Devoted Health Medicare |
$163.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Humana Medicare |
$148.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.50
|
| Rate for Payer: University Health Alliance Commercial |
$67.38
|
|
|
Culture, Viral, Respiratory and Cytomegalovirus FSI
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
8228940
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$26.07 |
| Max. Negotiated Rate |
$288.09 |
| Rate for Payer: AlohaCare Medicaid |
$148.50
|
| Rate for Payer: AlohaCare Medicare |
$148.50
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Devoted Health Medicare |
$163.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$36.02
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$32.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$148.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$37.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$26.07
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Humana Medicare |
$148.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$151.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$148.50
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$148.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$148.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.02
|
| Rate for Payer: UnitedHealthcare Medicare |
$148.50
|
| Rate for Payer: University Health Alliance Commercial |
$67.38
|
|
|
Culture, Viral, Respiratory and Cytomegalovirus FSI
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
HCPCS 87252
|
| Hospital Charge Code |
8228940
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$252.45 |
| Max. Negotiated Rate |
$288.09 |
| Rate for Payer: Cash Price |
$193.05
|
| Rate for Payer: Health Management Network Commercial |
$252.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$267.30
|
| Rate for Payer: MDX Hawaii PPO |
$288.09
|
|
|
Culture, VRE Surveillance
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
8228943
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: AlohaCare Medicaid |
$45.00
|
| Rate for Payer: AlohaCare Medicare |
$45.00
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Devoted Health Medicare |
$49.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$9.16
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$8.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$9.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.63
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Humana Medicare |
$45.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.00
|
| Rate for Payer: University Health Alliance Commercial |
$17.13
|
|
|
Culture, VRE Surveillance
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
HCPCS 87081
|
| Hospital Charge Code |
8228943
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$87.30 |
| Rate for Payer: Cash Price |
$58.50
|
| Rate for Payer: Health Management Network Commercial |
$76.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$81.00
|
| Rate for Payer: MDX Hawaii PPO |
$87.30
|
|
|
Culture, Wound, GS, Aero/Anaero FSI
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
10046576
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$56.95 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
|
|
Culture, Wound, GS, Aero/Anaero FSI
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
10046576
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$64.99 |
| Rate for Payer: AlohaCare Medicaid |
$33.50
|
| Rate for Payer: AlohaCare Medicare |
$33.50
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Cash Price |
$43.55
|
| Rate for Payer: Devoted Health Medicare |
$36.85
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$5.90
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$5.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$33.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$6.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.27
|
| Rate for Payer: Health Management Network Commercial |
$56.95
|
| Rate for Payer: Humana Medicare |
$33.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$60.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$33.50
|
| Rate for Payer: MDX Hawaii PPO |
$64.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$33.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$33.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$5.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$33.50
|
| Rate for Payer: University Health Alliance Commercial |
$11.03
|
|
|
CVC KIT 2 LUMEN 4 FR 13CM ARROW
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
9346685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$438.44 |
| Rate for Payer: AlohaCare Medicaid |
$226.00
|
| Rate for Payer: AlohaCare Medicare |
$226.00
|
| Rate for Payer: Cash Price |
$293.80
|
| Rate for Payer: Devoted Health Medicare |
$248.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$226.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$429.40
|
| Rate for Payer: Health Management Network Commercial |
$384.20
|
| Rate for Payer: Humana Medicare |
$226.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$406.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$230.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$226.00
|
| Rate for Payer: MDX Hawaii PPO |
$438.44
|
| Rate for Payer: Ohana Health Plan Medicaid |
$226.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$226.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$226.00
|
| Rate for Payer: University Health Alliance Commercial |
$329.46
|
|
|
CVC KIT 2 LUMEN 4 FR 13CM ARROW
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
9346685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.20 |
| Max. Negotiated Rate |
$438.44 |
| Rate for Payer: Cash Price |
$293.80
|
| Rate for Payer: Health Management Network Commercial |
$384.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$406.80
|
| Rate for Payer: MDX Hawaii PPO |
$438.44
|
|
|
CVC KIT 2 LUMEN 4FR 8CM ARROW
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
9346686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$231.50 |
| Max. Negotiated Rate |
$449.11 |
| Rate for Payer: AlohaCare Medicaid |
$231.50
|
| Rate for Payer: AlohaCare Medicare |
$231.50
|
| Rate for Payer: Cash Price |
$300.95
|
| Rate for Payer: Devoted Health Medicare |
$254.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$439.85
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Humana Medicare |
$231.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.13
|
| Rate for Payer: Kaiser Permanente Medicare |
$231.50
|
| Rate for Payer: MDX Hawaii PPO |
$449.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$231.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$231.50
|
| Rate for Payer: University Health Alliance Commercial |
$337.48
|
|
|
CVC KIT 2 LUMEN 4FR 8CM ARROW
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
9346686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.55 |
| Max. Negotiated Rate |
$449.11 |
| Rate for Payer: Cash Price |
$300.95
|
| Rate for Payer: Health Management Network Commercial |
$393.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.70
|
| Rate for Payer: MDX Hawaii PPO |
$449.11
|
|
|
CVC KIT 2 LUMEN 7 FR 16CM ARROW
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
9346683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: AlohaCare Medicaid |
$143.00
|
| Rate for Payer: AlohaCare Medicare |
$143.00
|
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Devoted Health Medicare |
$157.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$271.70
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Humana Medicare |
$143.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$145.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.00
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.00
|
| Rate for Payer: University Health Alliance Commercial |
$208.47
|
|
|
CVC KIT 2 LUMEN 7 FR 16CM ARROW
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
9346683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.10 |
| Max. Negotiated Rate |
$277.42 |
| Rate for Payer: Cash Price |
$185.90
|
| Rate for Payer: Health Management Network Commercial |
$243.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$257.40
|
| Rate for Payer: MDX Hawaii PPO |
$277.42
|
|
|
cyanocobalamin 1000 mcg/1mL vial [HHSC]
|
Facility
|
IP
|
$50.06
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2500211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Health Management Network Commercial |
$43.39
|
| Rate for Payer: Health Management Network Commercial |
$20.19
|
| Rate for Payer: Health Management Network Commercial |
$42.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.05
|
| Rate for Payer: MDX Hawaii PPO |
$48.56
|
| Rate for Payer: MDX Hawaii PPO |
$23.04
|
| Rate for Payer: MDX Hawaii PPO |
$49.52
|
|
|
cyanocobalamin 1000 mcg/1mL vial [HHSC]
|
Facility
|
OP
|
$50.06
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
2500211
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$48.56 |
| Rate for Payer: AlohaCare Medicaid |
$25.03
|
| Rate for Payer: AlohaCare Medicaid |
$25.52
|
| Rate for Payer: AlohaCare Medicaid |
$11.88
|
| Rate for Payer: AlohaCare Medicare |
$25.52
|
| Rate for Payer: AlohaCare Medicare |
$11.88
|
| Rate for Payer: AlohaCare Medicare |
$25.03
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$15.44
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Cash Price |
$32.54
|
| Rate for Payer: Devoted Health Medicare |
$28.08
|
| Rate for Payer: Devoted Health Medicare |
$27.53
|
| Rate for Payer: Devoted Health Medicare |
$13.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.95
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.03
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$25.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.88
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$47.56
|
| Rate for Payer: Health Management Network Commercial |
$20.19
|
| Rate for Payer: Health Management Network Commercial |
$42.55
|
| Rate for Payer: Health Management Network Commercial |
$43.39
|
| Rate for Payer: Humana Medicare |
$25.03
|
| Rate for Payer: Humana Medicare |
$11.88
|
| Rate for Payer: Humana Medicare |
$25.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.38
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.04
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$25.52
|
| Rate for Payer: MDX Hawaii PPO |
$49.52
|
| Rate for Payer: MDX Hawaii PPO |
$23.04
|
| Rate for Payer: MDX Hawaii PPO |
$48.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$25.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$25.03
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.88
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$25.03
|
| Rate for Payer: University Health Alliance Commercial |
$37.21
|
| Rate for Payer: University Health Alliance Commercial |
$36.49
|
| Rate for Payer: University Health Alliance Commercial |
$17.31
|
|
|
cyanocobalamin 1000 mcg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 50268085515
|
| Hospital Charge Code |
2500210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
cyanocobalamin 1000 mcg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 77333093810
|
| Hospital Charge Code |
2500210
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
