|
lidocaine-viscous 2% 15 mL [HHSC]
|
Facility
|
OP
|
$91.89
|
|
|
Service Code
|
NDC 62135071242
|
| Hospital Charge Code |
2500483
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$89.13 |
| Rate for Payer: AlohaCare Medicaid |
$45.95
|
| Rate for Payer: AlohaCare Medicare |
$45.95
|
| Rate for Payer: Cash Price |
$59.73
|
| Rate for Payer: Devoted Health Medicare |
$50.54
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.95
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$87.30
|
| Rate for Payer: Health Management Network Commercial |
$78.11
|
| Rate for Payer: Humana Medicare |
$45.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.86
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.95
|
| Rate for Payer: MDX Hawaii PPO |
$89.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.95
|
| Rate for Payer: UnitedHealthcare Medicaid |
$55.13
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.95
|
| Rate for Payer: University Health Alliance Commercial |
$66.98
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
OP
|
$57.97
|
|
|
Service Code
|
NDC 00168035755
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$56.23 |
| Rate for Payer: AlohaCare Medicaid |
$28.98
|
| Rate for Payer: AlohaCare Medicare |
$28.98
|
| Rate for Payer: Cash Price |
$37.68
|
| Rate for Payer: Devoted Health Medicare |
$31.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$55.07
|
| Rate for Payer: Health Management Network Commercial |
$49.27
|
| Rate for Payer: Humana Medicare |
$28.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.98
|
| Rate for Payer: MDX Hawaii PPO |
$56.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.78
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.98
|
| Rate for Payer: University Health Alliance Commercial |
$42.25
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
OP
|
$48.83
|
|
|
Service Code
|
NDC 00115146860
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.41 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: AlohaCare Medicaid |
$24.41
|
| Rate for Payer: AlohaCare Medicare |
$24.41
|
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Devoted Health Medicare |
$26.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$24.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.39
|
| Rate for Payer: Health Management Network Commercial |
$41.51
|
| Rate for Payer: Humana Medicare |
$24.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$24.41
|
| Rate for Payer: MDX Hawaii PPO |
$47.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$24.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$24.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.30
|
| Rate for Payer: UnitedHealthcare Medicare |
$24.41
|
| Rate for Payer: University Health Alliance Commercial |
$35.59
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
IP
|
$48.83
|
|
|
Service Code
|
NDC 00115146860
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.51 |
| Max. Negotiated Rate |
$47.37 |
| Rate for Payer: Cash Price |
$31.74
|
| Rate for Payer: Health Management Network Commercial |
$41.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.95
|
| Rate for Payer: MDX Hawaii PPO |
$47.37
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
OP
|
$54.39
|
|
|
Service Code
|
NDC 62332058204
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: AlohaCare Medicaid |
$27.20
|
| Rate for Payer: AlohaCare Medicare |
$27.20
|
| Rate for Payer: Cash Price |
$35.35
|
| Rate for Payer: Devoted Health Medicare |
$29.91
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$27.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$51.67
|
| Rate for Payer: Health Management Network Commercial |
$46.23
|
| Rate for Payer: Humana Medicare |
$27.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$27.20
|
| Rate for Payer: MDX Hawaii PPO |
$52.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$27.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$27.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$32.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$27.20
|
| Rate for Payer: University Health Alliance Commercial |
$39.64
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
IP
|
$52.81
|
|
|
Service Code
|
NDC 00591207072
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.89 |
| Max. Negotiated Rate |
$51.23 |
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Health Management Network Commercial |
$44.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.53
|
| Rate for Payer: MDX Hawaii PPO |
$51.23
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
IP
|
$57.97
|
|
|
Service Code
|
NDC 00168035755
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.27 |
| Max. Negotiated Rate |
$56.23 |
| Rate for Payer: Cash Price |
$37.68
|
| Rate for Payer: Health Management Network Commercial |
$49.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$52.17
|
| Rate for Payer: MDX Hawaii PPO |
$56.23
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
IP
|
$54.39
|
|
|
Service Code
|
NDC 62332058204
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$46.23 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Cash Price |
$35.35
|
| Rate for Payer: Health Management Network Commercial |
$46.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$48.95
|
| Rate for Payer: MDX Hawaii PPO |
$52.76
|
|
|
lido-prilocaine 2.5%-2.5% cream topical [HHSC]
|
Facility
|
OP
|
$52.81
|
|
|
Service Code
|
NDC 00591207072
|
| Hospital Charge Code |
2500487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$51.23 |
| Rate for Payer: AlohaCare Medicaid |
$26.41
|
| Rate for Payer: AlohaCare Medicare |
$26.41
|
| Rate for Payer: Cash Price |
$34.33
|
| Rate for Payer: Devoted Health Medicare |
$29.05
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.17
|
| Rate for Payer: Health Management Network Commercial |
$44.89
|
| Rate for Payer: Humana Medicare |
$26.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.53
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.41
|
| Rate for Payer: MDX Hawaii PPO |
$51.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.69
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.41
|
| Rate for Payer: University Health Alliance Commercial |
$38.49
|
|
|
LIGASURE 10MM
|
Facility
|
IP
|
$1,241.00
|
|
| Hospital Charge Code |
8428815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,054.85 |
| Max. Negotiated Rate |
$1,203.77 |
| Rate for Payer: Cash Price |
$806.65
|
| Rate for Payer: Health Management Network Commercial |
$1,054.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,116.90
|
| Rate for Payer: MDX Hawaii PPO |
$1,203.77
|
|
|
LIGASURE 10MM
|
Facility
|
OP
|
$1,241.00
|
|
| Hospital Charge Code |
8428815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.50 |
| Max. Negotiated Rate |
$1,203.77 |
| Rate for Payer: AlohaCare Medicaid |
$620.50
|
| Rate for Payer: AlohaCare Medicare |
$620.50
|
| Rate for Payer: Cash Price |
$806.65
|
| Rate for Payer: Devoted Health Medicare |
$682.55
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$620.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,178.95
|
| Rate for Payer: Health Management Network Commercial |
$1,054.85
|
| Rate for Payer: Humana Medicare |
$620.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,116.90
|
| Rate for Payer: Kaiser Permanente Medicaid |
$632.91
|
| Rate for Payer: Kaiser Permanente Medicare |
$620.50
|
| Rate for Payer: MDX Hawaii PPO |
$1,203.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$620.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$620.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$620.50
|
| Rate for Payer: University Health Alliance Commercial |
$904.56
|
|
|
LIGASURE, IMPACT SEALER/DIVIDER LF 4418
|
Facility
|
IP
|
$1,768.00
|
|
| Hospital Charge Code |
8274241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,502.80 |
| Max. Negotiated Rate |
$1,714.96 |
| Rate for Payer: Cash Price |
$1,149.20
|
| Rate for Payer: Health Management Network Commercial |
$1,502.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,591.20
|
| Rate for Payer: MDX Hawaii PPO |
$1,714.96
|
|
|
LIGASURE, IMPACT SEALER/DIVIDER LF 4418
|
Facility
|
OP
|
$1,768.00
|
|
| Hospital Charge Code |
8274241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.00 |
| Max. Negotiated Rate |
$1,714.96 |
| Rate for Payer: AlohaCare Medicaid |
$884.00
|
| Rate for Payer: AlohaCare Medicare |
$884.00
|
| Rate for Payer: Cash Price |
$1,149.20
|
| Rate for Payer: Devoted Health Medicare |
$972.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$884.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,679.60
|
| Rate for Payer: Health Management Network Commercial |
$1,502.80
|
| Rate for Payer: Humana Medicare |
$884.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,591.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$901.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$884.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,714.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$884.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$884.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$884.00
|
| Rate for Payer: University Health Alliance Commercial |
$1,288.70
|
|
|
LIGASURE, TISSUE FUSION LS1020
|
Facility
|
IP
|
$1,190.00
|
|
| Hospital Charge Code |
8274242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,011.50 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
|
|
LIGASURE, TISSUE FUSION LS1020
|
Facility
|
OP
|
$1,190.00
|
|
| Hospital Charge Code |
8274242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$1,154.30 |
| Rate for Payer: AlohaCare Medicaid |
$595.00
|
| Rate for Payer: AlohaCare Medicare |
$595.00
|
| Rate for Payer: Cash Price |
$773.50
|
| Rate for Payer: Devoted Health Medicare |
$654.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$595.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,130.50
|
| Rate for Payer: Health Management Network Commercial |
$1,011.50
|
| Rate for Payer: Humana Medicare |
$595.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,071.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$606.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$595.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,154.30
|
| Rate for Payer: Ohana Health Plan Medicaid |
$595.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$595.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$595.00
|
| Rate for Payer: University Health Alliance Commercial |
$867.39
|
|
|
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL OR VAGINAL APPROACH, UNILATERAL OR BILATERAL
|
Facility
|
OP
|
$7,085.00
|
|
|
Service Code
|
CPT 58600
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.03 |
| Max. Negotiated Rate |
$7,085.00 |
| Rate for Payer: Hawaii Medical Service Association ABD |
$848.00
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$7,085.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$849.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2,837.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$456.03
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$230,458.34
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$230,458.34 |
| Max. Negotiated Rate |
$230,458.34 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$230,458.34
|
|
|
LINER ARM DELTA TERRY-NET SYNTH 3X19 WHITE F/ THUMB SPICA 10/CA
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
12957407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicare |
$11.50
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Devoted Health Medicare |
$12.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Humana Medicare |
$11.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.50
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.50
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
|
|
LINER ARM DELTA TERRY-NET SYNTH 3X19 WHITE F/ THUMB SPICA 10/CA
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
12957407
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
|
|
LINER PADDING DELTA TERRY-NET CLOTH/ FOAM ADH 23X39 LF 1RL/BX
|
Facility
|
IP
|
$257.00
|
|
| Hospital Charge Code |
12957404
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$218.45 |
| Max. Negotiated Rate |
$249.29 |
| Rate for Payer: Cash Price |
$167.05
|
| Rate for Payer: Health Management Network Commercial |
$218.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$231.30
|
| Rate for Payer: MDX Hawaii PPO |
$249.29
|
|
|
LINER PADDING DELTA TERRY-NET CLOTH/ FOAM ADH 23X39 LF 1RL/BX
|
Facility
|
OP
|
$257.00
|
|
| Hospital Charge Code |
12957404
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$128.50 |
| Max. Negotiated Rate |
$249.29 |
| Rate for Payer: AlohaCare Medicaid |
$128.50
|
| Rate for Payer: AlohaCare Medicare |
$128.50
|
| Rate for Payer: Cash Price |
$167.05
|
| Rate for Payer: Devoted Health Medicare |
$141.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$128.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$244.15
|
| Rate for Payer: Health Management Network Commercial |
$218.45
|
| Rate for Payer: Humana Medicare |
$128.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$231.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$131.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$128.50
|
| Rate for Payer: MDX Hawaii PPO |
$249.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$128.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$128.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$128.50
|
| Rate for Payer: University Health Alliance Commercial |
$187.33
|
|
|
linezolid 600 mg/300 mL premix [HHSC]
|
Facility
|
IP
|
$178.66
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
2500488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$173.30 |
| Rate for Payer: Cash Price |
$116.13
|
| Rate for Payer: Cash Price |
$242.01
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$228.14
|
| Rate for Payer: Health Management Network Commercial |
$151.86
|
| Rate for Payer: Health Management Network Commercial |
$262.85
|
| Rate for Payer: Health Management Network Commercial |
$298.34
|
| Rate for Payer: Health Management Network Commercial |
$316.47
|
| Rate for Payer: Health Management Network Commercial |
$340.65
|
| Rate for Payer: Health Management Network Commercial |
$66.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$335.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.89
|
| Rate for Payer: MDX Hawaii PPO |
$340.46
|
| Rate for Payer: MDX Hawaii PPO |
$75.99
|
| Rate for Payer: MDX Hawaii PPO |
$388.75
|
| Rate for Payer: MDX Hawaii PPO |
$361.15
|
| Rate for Payer: MDX Hawaii PPO |
$173.30
|
| Rate for Payer: MDX Hawaii PPO |
$299.95
|
|
|
linezolid 600 mg/300 mL premix [HHSC]
|
Facility
|
OP
|
$372.32
|
|
|
Service Code
|
HCPCS J2020
|
| Hospital Charge Code |
2500488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$361.15 |
| Rate for Payer: AlohaCare Medicaid |
$186.16
|
| Rate for Payer: AlohaCare Medicaid |
$175.50
|
| Rate for Payer: AlohaCare Medicaid |
$154.62
|
| Rate for Payer: AlohaCare Medicaid |
$200.38
|
| Rate for Payer: AlohaCare Medicaid |
$89.33
|
| Rate for Payer: AlohaCare Medicaid |
$39.17
|
| Rate for Payer: AlohaCare Medicare |
$39.17
|
| Rate for Payer: AlohaCare Medicare |
$186.16
|
| Rate for Payer: AlohaCare Medicare |
$89.33
|
| Rate for Payer: AlohaCare Medicare |
$154.62
|
| Rate for Payer: AlohaCare Medicare |
$175.50
|
| Rate for Payer: AlohaCare Medicare |
$200.38
|
| Rate for Payer: Cash Price |
$228.14
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$228.14
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$242.01
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cash Price |
$116.13
|
| Rate for Payer: Cash Price |
$50.92
|
| Rate for Payer: Cash Price |
$260.50
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cash Price |
$242.01
|
| Rate for Payer: Cash Price |
$116.13
|
| Rate for Payer: Devoted Health Medicare |
$220.42
|
| Rate for Payer: Devoted Health Medicare |
$204.78
|
| Rate for Payer: Devoted Health Medicare |
$98.26
|
| Rate for Payer: Devoted Health Medicare |
$193.04
|
| Rate for Payer: Devoted Health Medicare |
$170.08
|
| Rate for Payer: Devoted Health Medicare |
$43.09
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$154.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$186.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$89.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$200.38
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.47
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$3.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$333.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$293.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$74.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$380.73
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$353.70
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$169.73
|
| Rate for Payer: Health Management Network Commercial |
$340.65
|
| Rate for Payer: Health Management Network Commercial |
$298.34
|
| Rate for Payer: Health Management Network Commercial |
$262.85
|
| Rate for Payer: Health Management Network Commercial |
$151.86
|
| Rate for Payer: Health Management Network Commercial |
$316.47
|
| Rate for Payer: Health Management Network Commercial |
$66.59
|
| Rate for Payer: Humana Medicare |
$154.62
|
| Rate for Payer: Humana Medicare |
$89.33
|
| Rate for Payer: Humana Medicare |
$175.50
|
| Rate for Payer: Humana Medicare |
$200.38
|
| Rate for Payer: Humana Medicare |
$186.16
|
| Rate for Payer: Humana Medicare |
$39.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$315.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$360.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$70.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$278.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$335.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$160.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$189.88
|
| Rate for Payer: Kaiser Permanente Medicaid |
$204.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$179.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$39.95
|
| Rate for Payer: Kaiser Permanente Medicaid |
$91.12
|
| Rate for Payer: Kaiser Permanente Medicaid |
$157.71
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$200.38
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$89.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$154.62
|
| Rate for Payer: MDX Hawaii PPO |
$173.30
|
| Rate for Payer: MDX Hawaii PPO |
$340.46
|
| Rate for Payer: MDX Hawaii PPO |
$299.95
|
| Rate for Payer: MDX Hawaii PPO |
$361.15
|
| Rate for Payer: MDX Hawaii PPO |
$75.99
|
| Rate for Payer: MDX Hawaii PPO |
$388.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.50
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$89.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$154.62
|
| Rate for Payer: Ohana Health Plan Medicaid |
$200.38
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$154.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$200.38
|
| Rate for Payer: Ohana Health Plan Medicare |
$186.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.17
|
| Rate for Payer: Ohana Health Plan Medicare |
$89.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$185.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$240.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$223.39
|
| Rate for Payer: UnitedHealthcare Medicaid |
$107.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$210.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$200.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$154.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$89.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$186.16
|
| Rate for Payer: University Health Alliance Commercial |
$292.12
|
| Rate for Payer: University Health Alliance Commercial |
$57.10
|
| Rate for Payer: University Health Alliance Commercial |
$271.38
|
| Rate for Payer: University Health Alliance Commercial |
$130.23
|
| Rate for Payer: University Health Alliance Commercial |
$225.40
|
| Rate for Payer: University Health Alliance Commercial |
$255.84
|
|
|
linezolid 600 mg tablet [HHSC]
|
Facility
|
OP
|
$625.85
|
|
|
Service Code
|
NDC 67877041984
|
| Hospital Charge Code |
2500489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$312.93 |
| Max. Negotiated Rate |
$607.07 |
| Rate for Payer: AlohaCare Medicaid |
$312.93
|
| Rate for Payer: AlohaCare Medicare |
$312.93
|
| Rate for Payer: Cash Price |
$406.80
|
| Rate for Payer: Devoted Health Medicare |
$344.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$312.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$594.56
|
| Rate for Payer: Health Management Network Commercial |
$531.97
|
| Rate for Payer: Humana Medicare |
$312.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$563.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$319.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$312.93
|
| Rate for Payer: MDX Hawaii PPO |
$607.07
|
| Rate for Payer: Ohana Health Plan Medicaid |
$312.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$312.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$375.51
|
| Rate for Payer: UnitedHealthcare Medicare |
$312.93
|
| Rate for Payer: University Health Alliance Commercial |
$456.18
|
|
|
linezolid 600 mg tablet [HHSC]
|
Facility
|
IP
|
$506.04
|
|
|
Service Code
|
NDC 60687030921
|
| Hospital Charge Code |
2500489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$430.13 |
| Max. Negotiated Rate |
$490.86 |
| Rate for Payer: Cash Price |
$328.93
|
| Rate for Payer: Health Management Network Commercial |
$430.13
|
| Rate for Payer: Kaiser Permanente Commercial |
$455.44
|
| Rate for Payer: MDX Hawaii PPO |
$490.86
|
|
