|
ENDO GIA ROTICULATOR 45/3.5
|
Facility
|
IP
|
$602.00
|
|
| Hospital Charge Code |
8274230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.70 |
| Max. Negotiated Rate |
$583.94 |
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Health Management Network Commercial |
$511.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.80
|
| Rate for Payer: MDX Hawaii PPO |
$583.94
|
|
|
ENDO GIA ROTICULATOR 45/3.5
|
Facility
|
OP
|
$602.00
|
|
| Hospital Charge Code |
8274230
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$583.94 |
| Rate for Payer: AlohaCare Medicaid |
$301.00
|
| Rate for Payer: AlohaCare Medicare |
$301.00
|
| Rate for Payer: Cash Price |
$391.30
|
| Rate for Payer: Devoted Health Medicare |
$331.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$301.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$571.90
|
| Rate for Payer: Health Management Network Commercial |
$511.70
|
| Rate for Payer: Humana Medicare |
$301.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$541.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$307.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$301.00
|
| Rate for Payer: MDX Hawaii PPO |
$583.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$301.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$301.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$301.00
|
| Rate for Payer: University Health Alliance Commercial |
$438.80
|
|
|
ENDO GIA UNIVERSAL 12MM HANDLE
|
Facility
|
IP
|
$479.00
|
|
| Hospital Charge Code |
8274210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.15 |
| Max. Negotiated Rate |
$464.63 |
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Health Management Network Commercial |
$407.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.10
|
| Rate for Payer: MDX Hawaii PPO |
$464.63
|
|
|
ENDO GIA UNIVERSAL 12MM HANDLE
|
Facility
|
OP
|
$479.00
|
|
| Hospital Charge Code |
8274210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.50 |
| Max. Negotiated Rate |
$464.63 |
| Rate for Payer: AlohaCare Medicaid |
$239.50
|
| Rate for Payer: AlohaCare Medicare |
$239.50
|
| Rate for Payer: Cash Price |
$311.35
|
| Rate for Payer: Devoted Health Medicare |
$263.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$239.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$455.05
|
| Rate for Payer: Health Management Network Commercial |
$407.15
|
| Rate for Payer: Humana Medicare |
$239.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$431.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$244.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$239.50
|
| Rate for Payer: MDX Hawaii PPO |
$464.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$239.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$239.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$239.50
|
| Rate for Payer: University Health Alliance Commercial |
$349.14
|
|
|
ENDO ROTH NET
|
Facility
|
OP
|
$394.00
|
|
| Hospital Charge Code |
8274215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.00 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: AlohaCare Medicaid |
$197.00
|
| Rate for Payer: AlohaCare Medicare |
$197.00
|
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Devoted Health Medicare |
$216.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$197.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$374.30
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Humana Medicare |
$197.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$200.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$197.00
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$197.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$197.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$197.00
|
| Rate for Payer: University Health Alliance Commercial |
$287.19
|
|
|
ENDO ROTH NET
|
Facility
|
IP
|
$394.00
|
|
| Hospital Charge Code |
8274215
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.90 |
| Max. Negotiated Rate |
$382.18 |
| Rate for Payer: Cash Price |
$256.10
|
| Rate for Payer: Health Management Network Commercial |
$334.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$354.60
|
| Rate for Payer: MDX Hawaii PPO |
$382.18
|
|
|
ENDO:TALON GRASPING DEVICE
|
Facility
|
IP
|
$590.00
|
|
| Hospital Charge Code |
12818165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$501.50 |
| Max. Negotiated Rate |
$572.30 |
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.00
|
| Rate for Payer: MDX Hawaii PPO |
$572.30
|
|
|
ENDO:TALON GRASPING DEVICE
|
Facility
|
OP
|
$590.00
|
|
| Hospital Charge Code |
12818165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.00 |
| Max. Negotiated Rate |
$572.30 |
| Rate for Payer: AlohaCare Medicaid |
$295.00
|
| Rate for Payer: AlohaCare Medicare |
$295.00
|
| Rate for Payer: Cash Price |
$383.50
|
| Rate for Payer: Devoted Health Medicare |
$324.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$560.50
|
| Rate for Payer: Health Management Network Commercial |
$501.50
|
| Rate for Payer: Humana Medicare |
$295.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$531.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$300.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.00
|
| Rate for Payer: MDX Hawaii PPO |
$572.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$295.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.00
|
| Rate for Payer: University Health Alliance Commercial |
$430.05
|
|
|
ENDOVASCULAR ABDOMINAL AORTA WITH ILIAC BRANCH PROCEDURES
|
Facility
|
IP
|
$103,309.79
|
|
|
Service Code
|
MSDRG 213
|
| Min. Negotiated Rate |
$103,309.79 |
| Max. Negotiated Rate |
$103,309.79 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$103,309.79
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$99,357.91
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$99,357.91 |
| Max. Negotiated Rate |
$99,357.91 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$99,357.91
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$86,533.42
|
|
|
Service Code
|
MSDRG 267
|
| Min. Negotiated Rate |
$86,533.42 |
| Max. Negotiated Rate |
$86,533.42 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$86,533.42
|
|
|
enoxaparin 100 mg/1mL syringe [HHSC]
|
Facility
|
OP
|
$114.86
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500288
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$111.41 |
| Rate for Payer: AlohaCare Medicaid |
$57.43
|
| Rate for Payer: AlohaCare Medicaid |
$58.94
|
| Rate for Payer: AlohaCare Medicaid |
$223.07
|
| Rate for Payer: AlohaCare Medicaid |
$32.45
|
| Rate for Payer: AlohaCare Medicaid |
$48.26
|
| Rate for Payer: AlohaCare Medicaid |
$34.55
|
| Rate for Payer: AlohaCare Medicare |
$223.07
|
| Rate for Payer: AlohaCare Medicare |
$48.26
|
| Rate for Payer: AlohaCare Medicare |
$58.94
|
| Rate for Payer: AlohaCare Medicare |
$34.55
|
| Rate for Payer: AlohaCare Medicare |
$57.43
|
| Rate for Payer: AlohaCare Medicare |
$32.45
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Devoted Health Medicare |
$64.83
|
| Rate for Payer: Devoted Health Medicare |
$53.09
|
| Rate for Payer: Devoted Health Medicare |
$35.70
|
| Rate for Payer: Devoted Health Medicare |
$245.38
|
| Rate for Payer: Devoted Health Medicare |
$63.17
|
| Rate for Payer: Devoted Health Medicare |
$38.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$32.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$223.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.94
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.26
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.12
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$423.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.98
|
| Rate for Payer: Health Management Network Commercial |
$82.04
|
| Rate for Payer: Health Management Network Commercial |
$100.19
|
| Rate for Payer: Health Management Network Commercial |
$58.74
|
| Rate for Payer: Health Management Network Commercial |
$55.16
|
| Rate for Payer: Health Management Network Commercial |
$97.63
|
| Rate for Payer: Health Management Network Commercial |
$379.23
|
| Rate for Payer: Humana Medicare |
$58.94
|
| Rate for Payer: Humana Medicare |
$48.26
|
| Rate for Payer: Humana Medicare |
$57.43
|
| Rate for Payer: Humana Medicare |
$32.45
|
| Rate for Payer: Humana Medicare |
$223.07
|
| Rate for Payer: Humana Medicare |
$34.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$227.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.23
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.58
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.55
|
| Rate for Payer: Kaiser Permanente Medicare |
$223.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$32.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.43
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.26
|
| Rate for Payer: MDX Hawaii PPO |
$93.62
|
| Rate for Payer: MDX Hawaii PPO |
$111.41
|
| Rate for Payer: MDX Hawaii PPO |
$62.95
|
| Rate for Payer: MDX Hawaii PPO |
$67.04
|
| Rate for Payer: MDX Hawaii PPO |
$114.33
|
| Rate for Payer: MDX Hawaii PPO |
$432.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$32.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.94
|
| Rate for Payer: Ohana Health Plan Medicaid |
$223.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$32.45
|
| Rate for Payer: Ohana Health Plan Medicare |
$223.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.55
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.43
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.26
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.92
|
| Rate for Payer: UnitedHealthcare Medicaid |
$267.69
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.26
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$223.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.55
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$32.45
|
| Rate for Payer: University Health Alliance Commercial |
$83.72
|
| Rate for Payer: University Health Alliance Commercial |
$47.31
|
| Rate for Payer: University Health Alliance Commercial |
$50.37
|
| Rate for Payer: University Health Alliance Commercial |
$70.35
|
| Rate for Payer: University Health Alliance Commercial |
$325.20
|
| Rate for Payer: University Health Alliance Commercial |
$85.92
|
|
|
enoxaparin 100 mg/1mL syringe [HHSC]
|
Facility
|
IP
|
$64.90
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$62.95 |
| Rate for Payer: Cash Price |
$42.18
|
| Rate for Payer: Cash Price |
$290.00
|
| Rate for Payer: Cash Price |
$62.74
|
| Rate for Payer: Cash Price |
$44.92
|
| Rate for Payer: Cash Price |
$76.62
|
| Rate for Payer: Cash Price |
$74.66
|
| Rate for Payer: Health Management Network Commercial |
$97.63
|
| Rate for Payer: Health Management Network Commercial |
$100.19
|
| Rate for Payer: Health Management Network Commercial |
$379.23
|
| Rate for Payer: Health Management Network Commercial |
$55.16
|
| Rate for Payer: Health Management Network Commercial |
$58.74
|
| Rate for Payer: Health Management Network Commercial |
$82.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$401.54
|
| Rate for Payer: MDX Hawaii PPO |
$432.77
|
| Rate for Payer: MDX Hawaii PPO |
$93.62
|
| Rate for Payer: MDX Hawaii PPO |
$67.04
|
| Rate for Payer: MDX Hawaii PPO |
$62.95
|
| Rate for Payer: MDX Hawaii PPO |
$111.41
|
| Rate for Payer: MDX Hawaii PPO |
$114.33
|
|
|
enoxaparin 30 mg/0.3 ml syringe [HHSC]
|
Facility
|
IP
|
$20.07
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.06 |
| Max. Negotiated Rate |
$19.47 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Health Management Network Commercial |
$15.71
|
| Rate for Payer: Health Management Network Commercial |
$17.06
|
| Rate for Payer: Health Management Network Commercial |
$17.07
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.06
|
| Rate for Payer: MDX Hawaii PPO |
$17.93
|
| Rate for Payer: MDX Hawaii PPO |
$19.48
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
| Rate for Payer: MDX Hawaii PPO |
$19.47
|
|
|
enoxaparin 30 mg/0.3 ml syringe [HHSC]
|
Facility
|
OP
|
$20.08
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500289
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$19.48 |
| Rate for Payer: AlohaCare Medicaid |
$10.04
|
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicaid |
$10.04
|
| Rate for Payer: AlohaCare Medicaid |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$9.24
|
| Rate for Payer: AlohaCare Medicare |
$10.04
|
| Rate for Payer: AlohaCare Medicare |
$10.04
|
| Rate for Payer: AlohaCare Medicare |
$22.29
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Cash Price |
$12.01
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Devoted Health Medicare |
$11.04
|
| Rate for Payer: Devoted Health Medicare |
$11.04
|
| Rate for Payer: Devoted Health Medicare |
$10.16
|
| Rate for Payer: Devoted Health Medicare |
$24.51
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.29
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.34
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Health Management Network Commercial |
$17.06
|
| Rate for Payer: Health Management Network Commercial |
$15.71
|
| Rate for Payer: Health Management Network Commercial |
$17.07
|
| Rate for Payer: Humana Medicare |
$10.04
|
| Rate for Payer: Humana Medicare |
$9.24
|
| Rate for Payer: Humana Medicare |
$10.04
|
| Rate for Payer: Humana Medicare |
$22.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.24
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
| Rate for Payer: MDX Hawaii PPO |
$19.48
|
| Rate for Payer: MDX Hawaii PPO |
$19.47
|
| Rate for Payer: MDX Hawaii PPO |
$17.93
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.09
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.24
|
| Rate for Payer: University Health Alliance Commercial |
$32.49
|
| Rate for Payer: University Health Alliance Commercial |
$14.64
|
| Rate for Payer: University Health Alliance Commercial |
$13.47
|
| Rate for Payer: University Health Alliance Commercial |
$14.63
|
|
|
enoxaparin 40 mg/0.4 ml syringe [HHSC]
|
Facility
|
OP
|
$18.75
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$18.19 |
| Rate for Payer: AlohaCare Medicaid |
$9.38
|
| Rate for Payer: AlohaCare Medicaid |
$12.28
|
| Rate for Payer: AlohaCare Medicaid |
$13.38
|
| Rate for Payer: AlohaCare Medicaid |
$22.37
|
| Rate for Payer: AlohaCare Medicaid |
$28.04
|
| Rate for Payer: AlohaCare Medicaid |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$13.38
|
| Rate for Payer: AlohaCare Medicare |
$28.04
|
| Rate for Payer: AlohaCare Medicare |
$12.28
|
| Rate for Payer: AlohaCare Medicare |
$23.10
|
| Rate for Payer: AlohaCare Medicare |
$9.38
|
| Rate for Payer: AlohaCare Medicare |
$22.37
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Devoted Health Medicare |
$13.50
|
| Rate for Payer: Devoted Health Medicare |
$30.84
|
| Rate for Payer: Devoted Health Medicare |
$24.61
|
| Rate for Payer: Devoted Health Medicare |
$14.71
|
| Rate for Payer: Devoted Health Medicare |
$10.31
|
| Rate for Payer: Devoted Health Medicare |
$25.41
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.38
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$23.10
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$25.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.32
|
| Rate for Payer: Health Management Network Commercial |
$47.67
|
| Rate for Payer: Health Management Network Commercial |
$20.87
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$15.94
|
| Rate for Payer: Health Management Network Commercial |
$22.74
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Humana Medicare |
$28.04
|
| Rate for Payer: Humana Medicare |
$9.38
|
| Rate for Payer: Humana Medicare |
$22.37
|
| Rate for Payer: Humana Medicare |
$13.38
|
| Rate for Payer: Humana Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.82
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$13.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$23.10
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.04
|
| Rate for Payer: MDX Hawaii PPO |
$54.40
|
| Rate for Payer: MDX Hawaii PPO |
$18.19
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$23.81
|
| Rate for Payer: MDX Hawaii PPO |
$25.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$23.10
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.28
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.73
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.72
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$23.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.28
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.37
|
| Rate for Payer: University Health Alliance Commercial |
$13.67
|
| Rate for Payer: University Health Alliance Commercial |
$32.61
|
| Rate for Payer: University Health Alliance Commercial |
$33.68
|
| Rate for Payer: University Health Alliance Commercial |
$40.88
|
| Rate for Payer: University Health Alliance Commercial |
$19.50
|
| Rate for Payer: University Health Alliance Commercial |
$17.89
|
|
|
enoxaparin 40 mg/0.4 ml syringe [HHSC]
|
Facility
|
IP
|
$44.74
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Cash Price |
$29.08
|
| Rate for Payer: Cash Price |
$17.39
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$30.03
|
| Rate for Payer: Cash Price |
$15.96
|
| Rate for Payer: Cash Price |
$12.19
|
| Rate for Payer: Health Management Network Commercial |
$15.94
|
| Rate for Payer: Health Management Network Commercial |
$20.87
|
| Rate for Payer: Health Management Network Commercial |
$22.74
|
| Rate for Payer: Health Management Network Commercial |
$38.03
|
| Rate for Payer: Health Management Network Commercial |
$39.27
|
| Rate for Payer: Health Management Network Commercial |
$47.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$41.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$16.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$24.07
|
| Rate for Payer: MDX Hawaii PPO |
$25.95
|
| Rate for Payer: MDX Hawaii PPO |
$54.40
|
| Rate for Payer: MDX Hawaii PPO |
$44.81
|
| Rate for Payer: MDX Hawaii PPO |
$43.40
|
| Rate for Payer: MDX Hawaii PPO |
$18.19
|
| Rate for Payer: MDX Hawaii PPO |
$23.81
|
|
|
enoxaparin 60 mg/0.6 ml syringe [HHSC]
|
Facility
|
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500291
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$23.37 |
| Rate for Payer: AlohaCare Medicaid |
$12.04
|
| Rate for Payer: AlohaCare Medicaid |
$20.53
|
| Rate for Payer: AlohaCare Medicaid |
$21.70
|
| Rate for Payer: AlohaCare Medicaid |
$22.42
|
| Rate for Payer: AlohaCare Medicaid |
$38.99
|
| Rate for Payer: AlohaCare Medicaid |
$31.14
|
| Rate for Payer: AlohaCare Medicare |
$21.70
|
| Rate for Payer: AlohaCare Medicare |
$38.99
|
| Rate for Payer: AlohaCare Medicare |
$20.53
|
| Rate for Payer: AlohaCare Medicare |
$31.14
|
| Rate for Payer: AlohaCare Medicare |
$12.04
|
| Rate for Payer: AlohaCare Medicare |
$22.42
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$50.69
|
| Rate for Payer: Cash Price |
$50.69
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Devoted Health Medicare |
$22.58
|
| Rate for Payer: Devoted Health Medicare |
$42.89
|
| Rate for Payer: Devoted Health Medicare |
$24.66
|
| Rate for Payer: Devoted Health Medicare |
$23.87
|
| Rate for Payer: Devoted Health Medicare |
$13.25
|
| Rate for Payer: Devoted Health Medicare |
$34.25
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.53
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$12.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$31.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$38.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$59.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$74.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.01
|
| Rate for Payer: Health Management Network Commercial |
$66.29
|
| Rate for Payer: Health Management Network Commercial |
$34.90
|
| Rate for Payer: Health Management Network Commercial |
$52.94
|
| Rate for Payer: Health Management Network Commercial |
$38.11
|
| Rate for Payer: Health Management Network Commercial |
$20.48
|
| Rate for Payer: Health Management Network Commercial |
$36.89
|
| Rate for Payer: Humana Medicare |
$20.53
|
| Rate for Payer: Humana Medicare |
$38.99
|
| Rate for Payer: Humana Medicare |
$12.04
|
| Rate for Payer: Humana Medicare |
$22.42
|
| Rate for Payer: Humana Medicare |
$21.70
|
| Rate for Payer: Humana Medicare |
$31.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.68
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.13
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$31.14
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$12.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$38.99
|
| Rate for Payer: MDX Hawaii PPO |
$75.65
|
| Rate for Payer: MDX Hawaii PPO |
$23.37
|
| Rate for Payer: MDX Hawaii PPO |
$43.49
|
| Rate for Payer: MDX Hawaii PPO |
$60.41
|
| Rate for Payer: MDX Hawaii PPO |
$39.83
|
| Rate for Payer: MDX Hawaii PPO |
$42.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$12.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$38.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.53
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.70
|
| Rate for Payer: Ohana Health Plan Medicare |
$31.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.53
|
| Rate for Payer: Ohana Health Plan Medicare |
$12.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$38.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$46.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$37.37
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.45
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.04
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$38.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$12.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$31.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.53
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.42
|
| Rate for Payer: University Health Alliance Commercial |
$17.56
|
| Rate for Payer: University Health Alliance Commercial |
$32.68
|
| Rate for Payer: University Health Alliance Commercial |
$45.40
|
| Rate for Payer: University Health Alliance Commercial |
$56.85
|
| Rate for Payer: University Health Alliance Commercial |
$31.63
|
| Rate for Payer: University Health Alliance Commercial |
$29.93
|
|
|
enoxaparin 60 mg/0.6 ml syringe [HHSC]
|
Facility
|
IP
|
$44.84
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500291
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.11 |
| Max. Negotiated Rate |
$43.49 |
| Rate for Payer: Cash Price |
$29.15
|
| Rate for Payer: Cash Price |
$28.21
|
| Rate for Payer: Cash Price |
$50.69
|
| Rate for Payer: Cash Price |
$40.48
|
| Rate for Payer: Cash Price |
$26.69
|
| Rate for Payer: Cash Price |
$15.66
|
| Rate for Payer: Health Management Network Commercial |
$20.48
|
| Rate for Payer: Health Management Network Commercial |
$34.90
|
| Rate for Payer: Health Management Network Commercial |
$36.89
|
| Rate for Payer: Health Management Network Commercial |
$38.11
|
| Rate for Payer: Health Management Network Commercial |
$52.94
|
| Rate for Payer: Health Management Network Commercial |
$66.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$56.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.06
|
| Rate for Payer: MDX Hawaii PPO |
$42.10
|
| Rate for Payer: MDX Hawaii PPO |
$75.65
|
| Rate for Payer: MDX Hawaii PPO |
$60.41
|
| Rate for Payer: MDX Hawaii PPO |
$43.49
|
| Rate for Payer: MDX Hawaii PPO |
$23.37
|
| Rate for Payer: MDX Hawaii PPO |
$39.83
|
|
|
enoxaparin 80 mg/0.8 ml syringe [HHSC]
|
Facility
|
IP
|
$56.63
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500292
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.14 |
| Max. Negotiated Rate |
$54.93 |
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$63.64
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$245.06
|
| Rate for Payer: Health Management Network Commercial |
$48.12
|
| Rate for Payer: Health Management Network Commercial |
$48.14
|
| Rate for Payer: Health Management Network Commercial |
$83.22
|
| Rate for Payer: Health Management Network Commercial |
$44.99
|
| Rate for Payer: Health Management Network Commercial |
$320.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.11
|
| Rate for Payer: MDX Hawaii PPO |
$54.93
|
| Rate for Payer: MDX Hawaii PPO |
$51.34
|
| Rate for Payer: MDX Hawaii PPO |
$365.70
|
| Rate for Payer: MDX Hawaii PPO |
$54.91
|
| Rate for Payer: MDX Hawaii PPO |
$94.96
|
|
|
enoxaparin 80 mg/0.8 ml syringe [HHSC]
|
Facility
|
OP
|
$56.61
|
|
|
Service Code
|
HCPCS J1650
|
| Hospital Charge Code |
2500292
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$54.91 |
| Rate for Payer: AlohaCare Medicaid |
$28.30
|
| Rate for Payer: AlohaCare Medicaid |
$26.46
|
| Rate for Payer: AlohaCare Medicaid |
$28.32
|
| Rate for Payer: AlohaCare Medicaid |
$48.95
|
| Rate for Payer: AlohaCare Medicaid |
$188.50
|
| Rate for Payer: AlohaCare Medicare |
$28.30
|
| Rate for Payer: AlohaCare Medicare |
$28.32
|
| Rate for Payer: AlohaCare Medicare |
$48.95
|
| Rate for Payer: AlohaCare Medicare |
$188.50
|
| Rate for Payer: AlohaCare Medicare |
$26.46
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cash Price |
$245.06
|
| Rate for Payer: Cash Price |
$245.06
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$63.64
|
| Rate for Payer: Cash Price |
$63.64
|
| Rate for Payer: Cash Price |
$36.81
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Devoted Health Medicare |
$31.14
|
| Rate for Payer: Devoted Health Medicare |
$207.36
|
| Rate for Payer: Devoted Health Medicare |
$31.15
|
| Rate for Payer: Devoted Health Medicare |
$53.84
|
| Rate for Payer: Devoted Health Medicare |
$29.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$188.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$48.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$358.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.80
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$93.00
|
| Rate for Payer: Health Management Network Commercial |
$48.12
|
| Rate for Payer: Health Management Network Commercial |
$44.99
|
| Rate for Payer: Health Management Network Commercial |
$320.46
|
| Rate for Payer: Health Management Network Commercial |
$83.22
|
| Rate for Payer: Health Management Network Commercial |
$48.14
|
| Rate for Payer: Humana Medicare |
$28.30
|
| Rate for Payer: Humana Medicare |
$188.50
|
| Rate for Payer: Humana Medicare |
$26.46
|
| Rate for Payer: Humana Medicare |
$28.32
|
| Rate for Payer: Humana Medicare |
$48.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$88.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$339.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$192.28
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$188.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.32
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$48.95
|
| Rate for Payer: MDX Hawaii PPO |
$54.91
|
| Rate for Payer: MDX Hawaii PPO |
$54.93
|
| Rate for Payer: MDX Hawaii PPO |
$51.34
|
| Rate for Payer: MDX Hawaii PPO |
$365.70
|
| Rate for Payer: MDX Hawaii PPO |
$94.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$188.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$48.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$48.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.32
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.30
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$188.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$226.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$58.74
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$188.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$48.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.30
|
| Rate for Payer: University Health Alliance Commercial |
$274.80
|
| Rate for Payer: University Health Alliance Commercial |
$41.26
|
| Rate for Payer: University Health Alliance Commercial |
$41.28
|
| Rate for Payer: University Health Alliance Commercial |
$38.58
|
| Rate for Payer: University Health Alliance Commercial |
$71.36
|
|
|
Enterovirus PCR, CSF FSI
|
Facility
|
IP
|
$392.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
8228866
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
|
|
Enterovirus PCR, CSF FSI
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
HCPCS 87498
|
| Hospital Charge Code |
8228866
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$380.24 |
| Rate for Payer: AlohaCare Medicaid |
$196.00
|
| Rate for Payer: AlohaCare Medicare |
$196.00
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Cash Price |
$254.80
|
| Rate for Payer: Devoted Health Medicare |
$215.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$49.04
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$196.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$51.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$333.20
|
| Rate for Payer: Humana Medicare |
$196.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$352.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$199.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$196.00
|
| Rate for Payer: MDX Hawaii PPO |
$380.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$196.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$196.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$196.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
Eosinophils Urine FSI
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
8404551
|
|
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
|
|
|
Eosinophils Urine FSI
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS 87205
|
| Hospital Charge Code |
8404551
|
|
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
|
|
