|
latanoprost ophthalmic 0.005% Sol 2.5mL [HHSC]
|
Facility
|
IP
|
$431.03
|
|
|
Service Code
|
NDC 61314054701
|
| Hospital Charge Code |
2500890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$366.38 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: Cash Price |
$280.17
|
| Rate for Payer: Health Management Network Commercial |
$366.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.93
|
| Rate for Payer: MDX Hawaii PPO |
$418.10
|
|
|
latanoprost ophthalmic 0.005% Sol 2.5mL [HHSC]
|
Facility
|
OP
|
$431.03
|
|
|
Service Code
|
NDC 70069042101
|
| Hospital Charge Code |
2500890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.51 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.51
|
| Rate for Payer: AlohaCare Medicare |
$215.51
|
| Rate for Payer: Cash Price |
$280.17
|
| Rate for Payer: Devoted Health Medicare |
$237.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$409.48
|
| Rate for Payer: Health Management Network Commercial |
$366.38
|
| Rate for Payer: Humana Medicare |
$215.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.51
|
| Rate for Payer: MDX Hawaii PPO |
$418.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$258.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.51
|
| Rate for Payer: University Health Alliance Commercial |
$314.18
|
|
|
latanoprost ophthalmic 0.005% Sol 2.5mL [HHSC]
|
Facility
|
IP
|
$431.03
|
|
|
Service Code
|
NDC 70069042101
|
| Hospital Charge Code |
2500890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$366.38 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: Cash Price |
$280.17
|
| Rate for Payer: Health Management Network Commercial |
$366.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.93
|
| Rate for Payer: MDX Hawaii PPO |
$418.10
|
|
|
latanoprost ophthalmic 0.005% Sol 2.5mL [HHSC]
|
Facility
|
OP
|
$431.03
|
|
|
Service Code
|
NDC 64980051625
|
| Hospital Charge Code |
2500890
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$215.51 |
| Max. Negotiated Rate |
$418.10 |
| Rate for Payer: AlohaCare Medicaid |
$215.51
|
| Rate for Payer: AlohaCare Medicare |
$215.51
|
| Rate for Payer: Cash Price |
$280.17
|
| Rate for Payer: Devoted Health Medicare |
$237.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$215.51
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$409.48
|
| Rate for Payer: Health Management Network Commercial |
$366.38
|
| Rate for Payer: Humana Medicare |
$215.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$387.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$219.83
|
| Rate for Payer: Kaiser Permanente Medicare |
$215.51
|
| Rate for Payer: MDX Hawaii PPO |
$418.10
|
| Rate for Payer: Ohana Health Plan Medicaid |
$215.51
|
| Rate for Payer: Ohana Health Plan Medicare |
$215.51
|
| Rate for Payer: UnitedHealthcare Medicaid |
$258.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$215.51
|
| Rate for Payer: University Health Alliance Commercial |
$314.18
|
|
|
LD, Body Fluid FSI
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
8228889
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$50.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.00
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.00
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
LD, Body Fluid FSI
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
8228889
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
LD (LDH) FSI
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
8117978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: AlohaCare Medicaid |
$46.00
|
| Rate for Payer: AlohaCare Medicare |
$46.00
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Devoted Health Medicare |
$50.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$8.35
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$46.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$8.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.04
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Humana Medicare |
$46.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$46.00
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
| Rate for Payer: Ohana Health Plan Medicaid |
$46.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$46.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$8.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$46.00
|
| Rate for Payer: University Health Alliance Commercial |
$15.61
|
|
|
LD (LDH) FSI
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
HCPCS 83615
|
| Hospital Charge Code |
8117978
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Cash Price |
$59.80
|
| Rate for Payer: Health Management Network Commercial |
$78.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.80
|
| Rate for Payer: MDX Hawaii PPO |
$89.24
|
|
|
Lead Blood (Capillary) FSI
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
8117979
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$70.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$77.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$70.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.28
|
|
|
Lead Blood (Capillary) FSI
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
8117979
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
Lead Blood (Venous) FSI
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
8117980
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
Lead Blood (Venous) FSI
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
8117980
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$70.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$77.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$70.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.28
|
|
|
Lead, Blood (Venous) FSI
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
12215068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
|
|
Lead, Blood (Venous) FSI
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS 83655
|
| Hospital Charge Code |
12215068
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$135.80 |
| Rate for Payer: AlohaCare Medicaid |
$70.00
|
| Rate for Payer: AlohaCare Medicare |
$70.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Cash Price |
$91.00
|
| Rate for Payer: Devoted Health Medicare |
$77.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.72
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$70.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$12.11
|
| Rate for Payer: Health Management Network Commercial |
$119.00
|
| Rate for Payer: Humana Medicare |
$70.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$70.00
|
| Rate for Payer: MDX Hawaii PPO |
$135.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$70.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$70.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$70.00
|
| Rate for Payer: University Health Alliance Commercial |
$31.28
|
|
|
Legionella pneumophila Antigen, Urine FSI
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
10408967
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$237.65 |
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.50
|
| Rate for Payer: MDX Hawaii PPO |
$237.65
|
|
|
Legionella pneumophila Antigen, Urine FSI
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS 87449
|
| Hospital Charge Code |
10408967
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$237.65 |
| Rate for Payer: AlohaCare Medicaid |
$122.50
|
| Rate for Payer: AlohaCare Medicare |
$122.50
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Cash Price |
$159.25
|
| Rate for Payer: Devoted Health Medicare |
$134.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$16.58
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14.97
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$17.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.98
|
| Rate for Payer: Health Management Network Commercial |
$208.25
|
| Rate for Payer: Humana Medicare |
$122.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$220.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$124.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.50
|
| Rate for Payer: MDX Hawaii PPO |
$237.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$16.58
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.50
|
| Rate for Payer: University Health Alliance Commercial |
$31.01
|
|
|
Leptin FSI
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
10046565
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$125.80 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
|
|
Leptin FSI
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
HCPCS 83520
|
| Hospital Charge Code |
10046565
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$143.56 |
| Rate for Payer: AlohaCare Medicaid |
$74.00
|
| Rate for Payer: AlohaCare Medicare |
$74.00
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Cash Price |
$96.20
|
| Rate for Payer: Devoted Health Medicare |
$81.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$74.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$18.78
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$125.80
|
| Rate for Payer: Humana Medicare |
$74.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$133.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$74.00
|
| Rate for Payer: MDX Hawaii PPO |
$143.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$74.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$74.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$74.00
|
| Rate for Payer: University Health Alliance Commercial |
$33.47
|
|
|
Leptospira Antibody FSI
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
8228890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: AlohaCare Medicaid |
$95.00
|
| Rate for Payer: AlohaCare Medicare |
$95.00
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Devoted Health Medicare |
$104.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.23
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.20
|
| Rate for Payer: Health Management Network Commercial |
$161.50
|
| Rate for Payer: Humana Medicare |
$95.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$96.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.00
|
| Rate for Payer: MDX Hawaii PPO |
$184.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.00
|
| Rate for Payer: University Health Alliance Commercial |
$34.10
|
|
|
Leptospira Antibody FSI
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS 86720
|
| Hospital Charge Code |
8228890
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$161.50 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Cash Price |
$123.50
|
| Rate for Payer: Health Management Network Commercial |
$161.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.00
|
| Rate for Payer: MDX Hawaii PPO |
$184.30
|
|
|
levalbuterol 0.63 mg/3 ml neb soln [HHSC]
|
Facility
|
IP
|
$41.04
|
|
|
Service Code
|
HCPCS J7614
|
| Hospital Charge Code |
2500453
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.88 |
| Max. Negotiated Rate |
$39.81 |
| Rate for Payer: Cash Price |
$26.68
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Health Management Network Commercial |
$35.98
|
| Rate for Payer: Health Management Network Commercial |
$9.45
|
| Rate for Payer: Health Management Network Commercial |
$34.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.94
|
| Rate for Payer: MDX Hawaii PPO |
$39.81
|
| Rate for Payer: MDX Hawaii PPO |
$10.79
|
| Rate for Payer: MDX Hawaii PPO |
$41.06
|
|
|
levalbuterol 0.63 mg/3 ml neb soln [HHSC]
|
Facility
|
OP
|
$41.04
|
|
|
Service Code
|
HCPCS J7614
|
| Hospital Charge Code |
2500453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$39.81 |
| Rate for Payer: AlohaCare Medicaid |
$20.52
|
| Rate for Payer: AlohaCare Medicaid |
$21.16
|
| Rate for Payer: AlohaCare Medicaid |
$5.56
|
| Rate for Payer: AlohaCare Medicare |
$21.16
|
| Rate for Payer: AlohaCare Medicare |
$5.56
|
| Rate for Payer: AlohaCare Medicare |
$20.52
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Cash Price |
$26.68
|
| Rate for Payer: Cash Price |
$26.68
|
| Rate for Payer: Devoted Health Medicare |
$23.28
|
| Rate for Payer: Devoted Health Medicare |
$22.57
|
| Rate for Payer: Devoted Health Medicare |
$6.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.09
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$40.21
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$38.99
|
| Rate for Payer: Health Management Network Commercial |
$9.45
|
| Rate for Payer: Health Management Network Commercial |
$34.88
|
| Rate for Payer: Health Management Network Commercial |
$35.98
|
| Rate for Payer: Humana Medicare |
$20.52
|
| Rate for Payer: Humana Medicare |
$5.56
|
| Rate for Payer: Humana Medicare |
$21.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$36.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$38.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.01
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.67
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.52
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.16
|
| Rate for Payer: MDX Hawaii PPO |
$41.06
|
| Rate for Payer: MDX Hawaii PPO |
$10.79
|
| Rate for Payer: MDX Hawaii PPO |
$39.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.52
|
| Rate for Payer: UnitedHealthcare Medicaid |
$6.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$25.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.52
|
| Rate for Payer: University Health Alliance Commercial |
$30.85
|
| Rate for Payer: University Health Alliance Commercial |
$29.91
|
| Rate for Payer: University Health Alliance Commercial |
$8.11
|
|
|
levalbuterol HFA 45 mcg inhaler [HHSC]
|
Facility
|
OP
|
$385.41
|
|
|
Service Code
|
NDC 63402051001
|
| Hospital Charge Code |
2500455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.71 |
| Max. Negotiated Rate |
$373.85 |
| Rate for Payer: AlohaCare Medicaid |
$192.71
|
| Rate for Payer: AlohaCare Medicare |
$192.71
|
| Rate for Payer: Cash Price |
$250.52
|
| Rate for Payer: Devoted Health Medicare |
$211.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$192.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$366.14
|
| Rate for Payer: Health Management Network Commercial |
$327.60
|
| Rate for Payer: Humana Medicare |
$192.71
|
| Rate for Payer: Kaiser Permanente Commercial |
$346.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$196.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$192.71
|
| Rate for Payer: MDX Hawaii PPO |
$373.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$192.71
|
| Rate for Payer: Ohana Health Plan Medicare |
$192.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$231.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$192.71
|
| Rate for Payer: University Health Alliance Commercial |
$280.93
|
|
|
levalbuterol HFA 45 mcg inhaler [HHSC]
|
Facility
|
IP
|
$356.91
|
|
|
Service Code
|
NDC 00591292754
|
| Hospital Charge Code |
2500455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$303.37 |
| Max. Negotiated Rate |
$346.20 |
| Rate for Payer: Cash Price |
$231.99
|
| Rate for Payer: Health Management Network Commercial |
$303.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.22
|
| Rate for Payer: MDX Hawaii PPO |
$346.20
|
|
|
levalbuterol HFA 45 mcg inhaler [HHSC]
|
Facility
|
OP
|
$356.91
|
|
|
Service Code
|
NDC 00591292754
|
| Hospital Charge Code |
2500455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$178.46 |
| Max. Negotiated Rate |
$346.20 |
| Rate for Payer: AlohaCare Medicaid |
$178.46
|
| Rate for Payer: AlohaCare Medicare |
$178.46
|
| Rate for Payer: Cash Price |
$231.99
|
| Rate for Payer: Devoted Health Medicare |
$196.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$178.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$339.06
|
| Rate for Payer: Health Management Network Commercial |
$303.37
|
| Rate for Payer: Humana Medicare |
$178.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$321.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$182.02
|
| Rate for Payer: Kaiser Permanente Medicare |
$178.46
|
| Rate for Payer: MDX Hawaii PPO |
$346.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$178.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$178.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$214.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$178.46
|
| Rate for Payer: University Health Alliance Commercial |
$260.15
|
|
