|
JAK2 Mut Rfx CALR MPL FSI
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
10596933
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$504.40 |
| Rate for Payer: Cash Price |
$338.00
|
| Rate for Payer: Health Management Network Commercial |
$442.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$468.00
|
| Rate for Payer: MDX Hawaii PPO |
$504.40
|
|
|
JAK2 V617F Mutation FSI
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
8808649
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$378.25 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: Cash Price |
$289.25
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.50
|
| Rate for Payer: MDX Hawaii PPO |
$431.65
|
|
|
JAK2 V617F Mutation FSI
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
8808649
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$431.65 |
| Rate for Payer: AlohaCare Medicaid |
$222.50
|
| Rate for Payer: AlohaCare Medicare |
$222.50
|
| Rate for Payer: Cash Price |
$289.25
|
| Rate for Payer: Cash Price |
$289.25
|
| Rate for Payer: Devoted Health Medicare |
$244.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$222.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.66
|
| Rate for Payer: Health Management Network Commercial |
$378.25
|
| Rate for Payer: Humana Medicare |
$222.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$400.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$226.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$222.50
|
| Rate for Payer: MDX Hawaii PPO |
$431.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$222.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$222.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$222.50
|
| Rate for Payer: University Health Alliance Commercial |
$230.79
|
|
|
JAK2 V617F Rfx Exon 12 FSI
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
10593920
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.73 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: AlohaCare Medicaid |
$315.00
|
| Rate for Payer: AlohaCare Medicare |
$315.00
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Devoted Health Medicare |
$346.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$122.70
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$114.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$315.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$122.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.66
|
| Rate for Payer: Health Management Network Commercial |
$535.50
|
| Rate for Payer: Humana Medicare |
$315.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$321.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$315.00
|
| Rate for Payer: MDX Hawaii PPO |
$611.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$315.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$315.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$49.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$315.00
|
| Rate for Payer: University Health Alliance Commercial |
$230.79
|
|
|
JAK2 V617F Rfx Exon 12 FSI
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS 81270
|
| Hospital Charge Code |
10593920
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$535.50 |
| Max. Negotiated Rate |
$611.10 |
| Rate for Payer: Cash Price |
$409.50
|
| Rate for Payer: Health Management Network Commercial |
$535.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$567.00
|
| Rate for Payer: MDX Hawaii PPO |
$611.10
|
|
|
Janssen Vaccine 0031A - Janssen Vaccine Admin Charge
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
HCPCS 0031A
|
| Hospital Charge Code |
9628231
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$50.50 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: AlohaCare Medicaid |
$50.50
|
| Rate for Payer: AlohaCare Medicare |
$50.50
|
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Devoted Health Medicare |
$55.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.95
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Humana Medicare |
$50.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.50
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.50
|
| Rate for Payer: University Health Alliance Commercial |
$73.62
|
|
|
Janssen Vaccine 0031A - Janssen Vaccine Admin Charge
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
HCPCS 0031A
|
| Hospital Charge Code |
9628231
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$85.85 |
| Max. Negotiated Rate |
$97.97 |
| Rate for Payer: Cash Price |
$65.65
|
| Rate for Payer: Health Management Network Commercial |
$85.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.90
|
| Rate for Payer: MDX Hawaii PPO |
$97.97
|
|
|
JP DRAIN 15F ROUND
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
8479432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: AlohaCare Medicaid |
$19.50
|
| Rate for Payer: AlohaCare Medicare |
$19.50
|
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Devoted Health Medicare |
$21.45
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.05
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Humana Medicare |
$19.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.50
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.50
|
| Rate for Payer: University Health Alliance Commercial |
$28.43
|
|
|
JP DRAIN 15F ROUND
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
8479432
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.15 |
| Max. Negotiated Rate |
$37.83 |
| Rate for Payer: Cash Price |
$25.35
|
| Rate for Payer: Health Management Network Commercial |
$33.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.10
|
| Rate for Payer: MDX Hawaii PPO |
$37.83
|
|
|
JP RESERVOIR 100ML
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
8479433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: AlohaCare Medicaid |
$27.50
|
| Rate for Payer: AlohaCare Medicare |
$27.50
|
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Devoted Health Medicare |
$30.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$52.25
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Humana Medicare |
$27.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.50
|
| Rate for Payer: University Health Alliance Commercial |
$40.09
|
|
|
JP RESERVOIR 100ML
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
8479433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.75 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Cash Price |
$35.75
|
| Rate for Payer: Health Management Network Commercial |
$46.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$49.50
|
| Rate for Payer: MDX Hawaii PPO |
$53.35
|
|
|
KATZ EXTRACTOR
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
8802544
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: AlohaCare Medicaid |
$130.00
|
| Rate for Payer: AlohaCare Medicare |
$130.00
|
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Devoted Health Medicare |
$143.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$130.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$247.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Humana Medicare |
$130.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$132.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$130.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$130.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$130.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$130.00
|
| Rate for Payer: University Health Alliance Commercial |
$189.51
|
|
|
KATZ EXTRACTOR
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
8802544
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$252.20 |
| Rate for Payer: Cash Price |
$169.00
|
| Rate for Payer: Health Management Network Commercial |
$221.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$234.00
|
| Rate for Payer: MDX Hawaii PPO |
$252.20
|
|
|
Keppra (Levetiracetam) FSI
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
8117977
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.85 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: AlohaCare Medicaid |
$63.00
|
| Rate for Payer: AlohaCare Medicare |
$63.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Devoted Health Medicare |
$69.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$11.11
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$63.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$13.25
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$64.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$63.00
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$63.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$63.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$10.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$63.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
Keppra (Levetiracetam) FSI
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS 80177
|
| Hospital Charge Code |
8117977
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$107.10 |
| Max. Negotiated Rate |
$122.22 |
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Health Management Network Commercial |
$107.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$113.40
|
| Rate for Payer: MDX Hawaii PPO |
$122.22
|
|
|
KERATOPLASTY (CORNEAL TRANSPLANT); ENDOTHELIAL
|
Facility
|
OP
|
$13,058.00
|
|
|
Service Code
|
CPT 65756
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$521.33 |
| Max. Negotiated Rate |
$13,058.00 |
| Rate for Payer: Hawaii Medical Service Association ABD |
$1,900.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,058.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1,902.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$521.33
|
| Rate for Payer: University Health Alliance Commercial |
$10,679.55
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Cash Price |
$37.87
|
| Rate for Payer: Health Management Network Commercial |
$49.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.43
|
| Rate for Payer: MDX Hawaii PPO |
$56.51
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
IP
|
$58.26
|
|
|
Service Code
|
NDC 00409004010
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.52 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: Cash Price |
$37.87
|
| Rate for Payer: Health Management Network Commercial |
$49.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.43
|
| Rate for Payer: MDX Hawaii PPO |
$56.51
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
IP
|
$57.16
|
|
|
Service Code
|
NDC 42023011510
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Health Management Network Commercial |
$48.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.44
|
| Rate for Payer: MDX Hawaii PPO |
$55.45
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
NDC 00409004010
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: AlohaCare Medicaid |
$29.13
|
| Rate for Payer: AlohaCare Medicare |
$29.13
|
| Rate for Payer: Cash Price |
$37.87
|
| Rate for Payer: Devoted Health Medicare |
$32.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.35
|
| Rate for Payer: Health Management Network Commercial |
$49.52
|
| Rate for Payer: Humana Medicare |
$29.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.13
|
| Rate for Payer: MDX Hawaii PPO |
$56.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.13
|
| Rate for Payer: University Health Alliance Commercial |
$42.47
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
IP
|
$56.43
|
|
|
Service Code
|
NDC 00143950910
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.97 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: Cash Price |
$36.68
|
| Rate for Payer: Health Management Network Commercial |
$47.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.79
|
| Rate for Payer: MDX Hawaii PPO |
$54.74
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
OP
|
$57.16
|
|
|
Service Code
|
NDC 42023011510
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.58 |
| Max. Negotiated Rate |
$55.45 |
| Rate for Payer: AlohaCare Medicaid |
$28.58
|
| Rate for Payer: AlohaCare Medicare |
$28.58
|
| Rate for Payer: Cash Price |
$37.15
|
| Rate for Payer: Devoted Health Medicare |
$31.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.30
|
| Rate for Payer: Health Management Network Commercial |
$48.59
|
| Rate for Payer: Humana Medicare |
$28.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.58
|
| Rate for Payer: MDX Hawaii PPO |
$55.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.58
|
| Rate for Payer: University Health Alliance Commercial |
$41.66
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
OP
|
$58.26
|
|
|
Service Code
|
NDC 00409205105
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.13 |
| Max. Negotiated Rate |
$56.51 |
| Rate for Payer: AlohaCare Medicaid |
$29.13
|
| Rate for Payer: AlohaCare Medicare |
$29.13
|
| Rate for Payer: Cash Price |
$37.87
|
| Rate for Payer: Devoted Health Medicare |
$32.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$29.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.35
|
| Rate for Payer: Health Management Network Commercial |
$49.52
|
| Rate for Payer: Humana Medicare |
$29.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$29.13
|
| Rate for Payer: MDX Hawaii PPO |
$56.51
|
| Rate for Payer: Ohana Health Plan Medicaid |
$29.13
|
| Rate for Payer: Ohana Health Plan Medicare |
$29.13
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$29.13
|
| Rate for Payer: University Health Alliance Commercial |
$42.47
|
|
|
ketamine 500 mg/5ml vial [HHSC]
|
Facility
|
OP
|
$56.43
|
|
|
Service Code
|
NDC 00143950910
|
| Hospital Charge Code |
2500435
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.21 |
| Max. Negotiated Rate |
$54.74 |
| Rate for Payer: AlohaCare Medicaid |
$28.21
|
| Rate for Payer: AlohaCare Medicare |
$28.21
|
| Rate for Payer: Cash Price |
$36.68
|
| Rate for Payer: Devoted Health Medicare |
$31.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.61
|
| Rate for Payer: Health Management Network Commercial |
$47.97
|
| Rate for Payer: Humana Medicare |
$28.21
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.21
|
| Rate for Payer: MDX Hawaii PPO |
$54.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.21
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.86
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.21
|
| Rate for Payer: University Health Alliance Commercial |
$41.13
|
|
|
ketoconazole 2% cream topical 60 gm [HHSC]
|
Facility
|
IP
|
$375.80
|
|
|
Service Code
|
NDC 00168009960
|
| Hospital Charge Code |
2500437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$319.43 |
| Max. Negotiated Rate |
$364.53 |
| Rate for Payer: Cash Price |
$244.27
|
| Rate for Payer: Health Management Network Commercial |
$319.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$338.22
|
| Rate for Payer: MDX Hawaii PPO |
$364.53
|
|
