|
insulin NPH 100 units/1mL 10 mL vial [HHSC]
|
Facility
|
IP
|
$301.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2500420
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$256.45 |
| Max. Negotiated Rate |
$292.66 |
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Cash Price |
$376.56
|
| Rate for Payer: Health Management Network Commercial |
$492.43
|
| Rate for Payer: Health Management Network Commercial |
$243.70
|
| Rate for Payer: Health Management Network Commercial |
$256.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$521.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.54
|
| Rate for Payer: MDX Hawaii PPO |
$292.66
|
| Rate for Payer: MDX Hawaii PPO |
$278.11
|
| Rate for Payer: MDX Hawaii PPO |
$561.95
|
|
|
insulin NPH 100 units/mL 3 mL pen [HHSC]
|
Facility
|
OP
|
$109.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: AlohaCare Medicaid |
$54.77
|
| Rate for Payer: AlohaCare Medicaid |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$80.00
|
| Rate for Payer: AlohaCare Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Devoted Health Medicare |
$60.24
|
| Rate for Payer: Devoted Health Medicare |
$87.99
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$151.99
|
| Rate for Payer: Health Management Network Commercial |
$135.99
|
| Rate for Payer: Health Management Network Commercial |
$93.10
|
| Rate for Payer: Humana Medicare |
$54.77
|
| Rate for Payer: Humana Medicare |
$80.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$81.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.00
|
| Rate for Payer: MDX Hawaii PPO |
$106.24
|
| Rate for Payer: MDX Hawaii PPO |
$155.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$95.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$65.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.00
|
| Rate for Payer: University Health Alliance Commercial |
$79.84
|
| Rate for Payer: University Health Alliance Commercial |
$116.62
|
|
|
insulin NPH 100 units/mL 3 mL pen [HHSC]
|
Facility
|
IP
|
$109.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501157
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Cash Price |
$103.99
|
| Rate for Payer: Health Management Network Commercial |
$93.10
|
| Rate for Payer: Health Management Network Commercial |
$135.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$143.99
|
| Rate for Payer: MDX Hawaii PPO |
$155.19
|
| Rate for Payer: MDX Hawaii PPO |
$106.24
|
|
|
insulin R 100 units/1 mL 10 mL vial [HHSC]
|
Facility
|
OP
|
$286.71
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501144
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$278.11 |
| Rate for Payer: Kaiser Permanente Medicare |
$143.34
|
| Rate for Payer: AlohaCare Medicaid |
$143.35
|
| Rate for Payer: AlohaCare Medicaid |
$150.85
|
| Rate for Payer: AlohaCare Medicaid |
$143.34
|
| Rate for Payer: AlohaCare Medicare |
$143.35
|
| Rate for Payer: AlohaCare Medicare |
$143.34
|
| Rate for Payer: AlohaCare Medicare |
$150.85
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Cash Price |
$186.34
|
| Rate for Payer: Cash Price |
$186.34
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Devoted Health Medicare |
$165.94
|
| Rate for Payer: Devoted Health Medicare |
$157.69
|
| Rate for Payer: Devoted Health Medicare |
$157.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$143.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$286.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$272.37
|
| Rate for Payer: Health Management Network Commercial |
$243.68
|
| Rate for Payer: Health Management Network Commercial |
$243.70
|
| Rate for Payer: Health Management Network Commercial |
$256.45
|
| Rate for Payer: Humana Medicare |
$143.35
|
| Rate for Payer: Humana Medicare |
$143.34
|
| Rate for Payer: Humana Medicare |
$150.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$153.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$146.21
|
| Rate for Payer: Kaiser Permanente Medicare |
$143.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.85
|
| Rate for Payer: MDX Hawaii PPO |
$278.08
|
| Rate for Payer: MDX Hawaii PPO |
$292.66
|
| Rate for Payer: MDX Hawaii PPO |
$278.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$143.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$143.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$143.35
|
| Rate for Payer: University Health Alliance Commercial |
$219.92
|
| Rate for Payer: University Health Alliance Commercial |
$208.96
|
| Rate for Payer: University Health Alliance Commercial |
$208.98
|
|
|
insulin R 100 units/1 mL 10 mL vial [HHSC]
|
Facility
|
IP
|
$286.68
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501144
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$243.68 |
| Max. Negotiated Rate |
$278.08 |
| Rate for Payer: Cash Price |
$186.34
|
| Rate for Payer: Cash Price |
$196.11
|
| Rate for Payer: Cash Price |
$186.36
|
| Rate for Payer: Health Management Network Commercial |
$243.68
|
| Rate for Payer: Health Management Network Commercial |
$256.45
|
| Rate for Payer: Health Management Network Commercial |
$243.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$258.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$271.54
|
| Rate for Payer: MDX Hawaii PPO |
$278.08
|
| Rate for Payer: MDX Hawaii PPO |
$278.11
|
| Rate for Payer: MDX Hawaii PPO |
$292.66
|
|
|
insulin R 100 units/mL 3 mL pen [HHSC]
|
Facility
|
OP
|
$109.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501154
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.90 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: AlohaCare Medicaid |
$54.77
|
| Rate for Payer: AlohaCare Medicare |
$54.77
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Devoted Health Medicare |
$60.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.90
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$54.77
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$104.05
|
| Rate for Payer: Health Management Network Commercial |
$93.10
|
| Rate for Payer: Humana Medicare |
$54.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$54.77
|
| Rate for Payer: MDX Hawaii PPO |
$106.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$54.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$54.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$54.77
|
| Rate for Payer: University Health Alliance Commercial |
$79.84
|
|
|
insulin R 100 units/mL 3 mL pen [HHSC]
|
Facility
|
IP
|
$109.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
2501154
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$106.24 |
| Rate for Payer: Cash Price |
$71.19
|
| Rate for Payer: Health Management Network Commercial |
$93.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$98.58
|
| Rate for Payer: MDX Hawaii PPO |
$106.24
|
|
|
INTERSTITIAL LUNG DISEASE WITH CC
|
Facility
|
IP
|
$36,994.70
|
|
|
Service Code
|
MSDRG 197
|
| Min. Negotiated Rate |
$36,994.70 |
| Max. Negotiated Rate |
$36,994.70 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36,994.70
|
|
|
INTERSTITIAL LUNG DISEASE WITH MCC
|
Facility
|
IP
|
$36,994.70
|
|
|
Service Code
|
MSDRG 196
|
| Min. Negotiated Rate |
$36,994.70 |
| Max. Negotiated Rate |
$36,994.70 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36,994.70
|
|
|
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$36,994.70
|
|
|
Service Code
|
MSDRG 198
|
| Min. Negotiated Rate |
$36,994.70 |
| Max. Negotiated Rate |
$36,994.70 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$36,994.70
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS
|
Facility
|
IP
|
$37,020.19
|
|
|
Service Code
|
MSDRG 065
|
| Min. Negotiated Rate |
$37,020.19 |
| Max. Negotiated Rate |
$37,020.19 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37,020.19
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC
|
Facility
|
IP
|
$37,020.19
|
|
|
Service Code
|
MSDRG 064
|
| Min. Negotiated Rate |
$37,020.19 |
| Max. Negotiated Rate |
$37,020.19 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37,020.19
|
|
|
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$37,020.19
|
|
|
Service Code
|
MSDRG 066
|
| Min. Negotiated Rate |
$37,020.19 |
| Max. Negotiated Rate |
$37,020.19 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$37,020.19
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC
|
Facility
|
IP
|
$263,858.10
|
|
|
Service Code
|
MSDRG 021
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$263,858.10 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$263,858.10
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$263,858.10
|
|
|
Service Code
|
MSDRG 020
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$263,858.10 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$263,858.10
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$263,858.10
|
|
|
Service Code
|
MSDRG 022
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$263,858.10 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$263,858.10
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
INTRAOCULAR PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$19,912.38
|
|
|
Service Code
|
MSDRG 116
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$19,912.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19,912.38
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
INTRAOCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$19,733.90
|
|
|
Service Code
|
MSDRG 117
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$19,733.90 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$19,733.90
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
Intubation Endotracheal Emergency Procedure [HHSC]
|
Facility
|
IP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
12507498
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$987.70 |
| Max. Negotiated Rate |
$1,127.14 |
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Health Management Network Commercial |
$987.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,045.80
|
| Rate for Payer: MDX Hawaii PPO |
$1,127.14
|
|
|
Intubation Endotracheal Emergency Procedure [HHSC]
|
Facility
|
OP
|
$1,162.00
|
|
|
Service Code
|
HCPCS 31500
|
| Hospital Charge Code |
12507498
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$4,035.20 |
| Rate for Payer: AlohaCare Medicaid |
$525.09
|
| Rate for Payer: AlohaCare Medicare |
$581.00
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Cash Price |
$755.30
|
| Rate for Payer: Devoted Health Medicare |
$639.10
|
| 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 |
$581.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$407.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,103.90
|
| Rate for Payer: Health Management Network Commercial |
$987.70
|
| Rate for Payer: Humana Medicare |
$581.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,045.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$937.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$581.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,127.14
|
| Rate for Payer: Ohana Health Plan Medicaid |
$581.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$581.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$581.00
|
| Rate for Payer: University Health Alliance Commercial |
$4,035.20
|
|
|
iodixanol 320 mg/mL (PF) 100 mL [HHSC]
|
Facility
|
OP
|
$507.67
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
2501017
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$492.44 |
| Rate for Payer: AlohaCare Medicaid |
$253.84
|
| Rate for Payer: AlohaCare Medicaid |
$264.75
|
| Rate for Payer: AlohaCare Medicare |
$264.75
|
| Rate for Payer: AlohaCare Medicare |
$253.84
|
| Rate for Payer: Cash Price |
$344.18
|
| Rate for Payer: Cash Price |
$329.99
|
| Rate for Payer: Cash Price |
$329.99
|
| Rate for Payer: Cash Price |
$344.18
|
| Rate for Payer: Devoted Health Medicare |
$279.22
|
| Rate for Payer: Devoted Health Medicare |
$291.23
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$264.75
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$253.84
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$482.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$503.02
|
| Rate for Payer: Health Management Network Commercial |
$450.07
|
| Rate for Payer: Health Management Network Commercial |
$431.52
|
| Rate for Payer: Humana Medicare |
$253.84
|
| Rate for Payer: Humana Medicare |
$264.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$456.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$270.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$258.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$253.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$264.75
|
| Rate for Payer: MDX Hawaii PPO |
$492.44
|
| Rate for Payer: MDX Hawaii PPO |
$513.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$264.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$253.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$253.84
|
| Rate for Payer: Ohana Health Plan Medicare |
$264.75
|
| Rate for Payer: UnitedHealthcare Medicaid |
$317.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$304.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$253.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$264.75
|
| Rate for Payer: University Health Alliance Commercial |
$370.04
|
| Rate for Payer: University Health Alliance Commercial |
$385.95
|
|
|
iodixanol 320 mg/mL (PF) 100 mL [HHSC]
|
Facility
|
IP
|
$507.67
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
2501017
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$431.52 |
| Max. Negotiated Rate |
$492.44 |
| Rate for Payer: Cash Price |
$329.99
|
| Rate for Payer: Cash Price |
$344.18
|
| Rate for Payer: Health Management Network Commercial |
$431.52
|
| Rate for Payer: Health Management Network Commercial |
$450.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$456.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$476.55
|
| Rate for Payer: MDX Hawaii PPO |
$513.62
|
| Rate for Payer: MDX Hawaii PPO |
$492.44
|
|
|
iohexol 12 mg/mL 500 mL oral solution [HHSC]
|
Facility
|
IP
|
$70.82
|
|
|
Service Code
|
NDC 00407141612
|
| Hospital Charge Code |
2501118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: Cash Price |
$46.03
|
| Rate for Payer: Health Management Network Commercial |
$60.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.74
|
| Rate for Payer: MDX Hawaii PPO |
$68.70
|
|
|
iohexol 12 mg/mL 500 mL oral solution [HHSC]
|
Facility
|
OP
|
$70.82
|
|
|
Service Code
|
NDC 00407141612
|
| Hospital Charge Code |
2501118
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.41 |
| Max. Negotiated Rate |
$68.70 |
| Rate for Payer: AlohaCare Medicaid |
$35.41
|
| Rate for Payer: AlohaCare Medicare |
$35.41
|
| Rate for Payer: Cash Price |
$46.03
|
| Rate for Payer: Devoted Health Medicare |
$38.95
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$67.28
|
| Rate for Payer: Health Management Network Commercial |
$60.20
|
| Rate for Payer: Humana Medicare |
$35.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$63.74
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.41
|
| Rate for Payer: MDX Hawaii PPO |
$68.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$42.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.41
|
| Rate for Payer: University Health Alliance Commercial |
$51.62
|
|
|
iohexol 300 mg/mL (PF) 100 mL [HHSC]
|
Facility
|
OP
|
$463.12
|
|
|
Service Code
|
HCPCS Q9967
|
| Hospital Charge Code |
2501018
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$449.23 |
| Rate for Payer: AlohaCare Medicaid |
$231.56
|
| Rate for Payer: AlohaCare Medicaid |
$234.85
|
| Rate for Payer: AlohaCare Medicare |
$234.85
|
| Rate for Payer: AlohaCare Medicare |
$231.56
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Cash Price |
$301.03
|
| Rate for Payer: Cash Price |
$301.03
|
| Rate for Payer: Cash Price |
$305.30
|
| Rate for Payer: Devoted Health Medicare |
$254.72
|
| Rate for Payer: Devoted Health Medicare |
$258.33
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.15
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.15
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$234.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$231.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.15
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$439.96
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$446.21
|
| Rate for Payer: Health Management Network Commercial |
$399.25
|
| Rate for Payer: Health Management Network Commercial |
$393.65
|
| Rate for Payer: Humana Medicare |
$231.56
|
| Rate for Payer: Humana Medicare |
$234.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$416.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.55
|
| Rate for Payer: Kaiser Permanente Medicaid |
$236.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$231.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$234.85
|
| Rate for Payer: MDX Hawaii PPO |
$449.23
|
| Rate for Payer: MDX Hawaii PPO |
$455.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$234.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$231.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$231.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$234.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$281.82
|
| Rate for Payer: UnitedHealthcare Medicaid |
$277.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$231.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$234.85
|
| Rate for Payer: University Health Alliance Commercial |
$337.57
|
| Rate for Payer: University Health Alliance Commercial |
$342.36
|
|
