|
MEDIHONEY HYDROCOLLOID PASTE 1.5 OZ
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
8419564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: AlohaCare Medicaid |
$64.00
|
| Rate for Payer: AlohaCare Medicare |
$64.00
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Devoted Health Medicare |
$70.40
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$64.00
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$121.60
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Humana Medicare |
$64.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$65.28
|
| Rate for Payer: Kaiser Permanente Medicare |
$64.00
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$64.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$64.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$76.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$64.00
|
| Rate for Payer: University Health Alliance Commercial |
$93.30
|
|
|
MEDIHONEY HYDROCOLLOID PASTE 1.5 OZ
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
8419564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$124.16 |
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Health Management Network Commercial |
$108.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$115.20
|
| Rate for Payer: MDX Hawaii PPO |
$124.16
|
|
|
medroxyPROGESTERone 150 mg/ml vial [HHSC]
|
Facility
|
OP
|
$201.94
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
2500516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$195.88 |
| Rate for Payer: AlohaCare Medicaid |
$100.97
|
| Rate for Payer: AlohaCare Medicaid |
$144.18
|
| Rate for Payer: AlohaCare Medicaid |
$95.33
|
| Rate for Payer: AlohaCare Medicaid |
$220.47
|
| Rate for Payer: AlohaCare Medicare |
$220.47
|
| Rate for Payer: AlohaCare Medicare |
$95.33
|
| Rate for Payer: AlohaCare Medicare |
$100.97
|
| Rate for Payer: AlohaCare Medicare |
$144.18
|
| Rate for Payer: Cash Price |
$286.62
|
| Rate for Payer: Cash Price |
$131.26
|
| Rate for Payer: Cash Price |
$123.93
|
| Rate for Payer: Cash Price |
$286.62
|
| Rate for Payer: Cash Price |
$123.93
|
| Rate for Payer: Cash Price |
$187.43
|
| Rate for Payer: Cash Price |
$131.26
|
| Rate for Payer: Cash Price |
$187.43
|
| Rate for Payer: Devoted Health Medicare |
$158.59
|
| Rate for Payer: Devoted Health Medicare |
$111.07
|
| Rate for Payer: Devoted Health Medicare |
$242.52
|
| Rate for Payer: Devoted Health Medicare |
$104.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$95.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$220.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$144.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.97
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.57
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$418.90
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$273.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$181.13
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$191.84
|
| Rate for Payer: Health Management Network Commercial |
$245.10
|
| Rate for Payer: Health Management Network Commercial |
$162.06
|
| Rate for Payer: Health Management Network Commercial |
$171.65
|
| Rate for Payer: Health Management Network Commercial |
$374.81
|
| Rate for Payer: Humana Medicare |
$95.33
|
| Rate for Payer: Humana Medicare |
$144.18
|
| Rate for Payer: Humana Medicare |
$100.97
|
| Rate for Payer: Humana Medicare |
$220.47
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$147.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$97.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$224.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$144.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$95.33
|
| Rate for Payer: Kaiser Permanente Medicare |
$220.47
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.97
|
| Rate for Payer: MDX Hawaii PPO |
$279.70
|
| Rate for Payer: MDX Hawaii PPO |
$184.94
|
| Rate for Payer: MDX Hawaii PPO |
$427.72
|
| Rate for Payer: MDX Hawaii PPO |
$195.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.97
|
| Rate for Payer: Ohana Health Plan Medicaid |
$144.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$95.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$220.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$220.47
|
| Rate for Payer: Ohana Health Plan Medicare |
$144.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.97
|
| Rate for Payer: Ohana Health Plan Medicare |
$95.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$121.16
|
| Rate for Payer: UnitedHealthcare Medicaid |
$173.01
|
| Rate for Payer: UnitedHealthcare Medicaid |
$114.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$264.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$95.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$144.18
|
| Rate for Payer: UnitedHealthcare Medicare |
$220.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.97
|
| Rate for Payer: University Health Alliance Commercial |
$138.97
|
| Rate for Payer: University Health Alliance Commercial |
$147.19
|
| Rate for Payer: University Health Alliance Commercial |
$210.18
|
| Rate for Payer: University Health Alliance Commercial |
$321.41
|
|
|
medroxyPROGESTERone 150 mg/ml vial [HHSC]
|
Facility
|
IP
|
$201.94
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
2500516
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$171.65 |
| Max. Negotiated Rate |
$195.88 |
| Rate for Payer: Cash Price |
$131.26
|
| Rate for Payer: Cash Price |
$286.62
|
| Rate for Payer: Cash Price |
$123.93
|
| Rate for Payer: Cash Price |
$187.43
|
| Rate for Payer: Health Management Network Commercial |
$162.06
|
| Rate for Payer: Health Management Network Commercial |
$374.81
|
| Rate for Payer: Health Management Network Commercial |
$171.65
|
| Rate for Payer: Health Management Network Commercial |
$245.10
|
| Rate for Payer: Kaiser Permanente Commercial |
$171.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$396.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$259.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$181.75
|
| Rate for Payer: MDX Hawaii PPO |
$427.72
|
| Rate for Payer: MDX Hawaii PPO |
$184.94
|
| Rate for Payer: MDX Hawaii PPO |
$195.88
|
| Rate for Payer: MDX Hawaii PPO |
$279.70
|
|
|
megestrol 400 mg/10 mL susp UD [HHSC]
|
Facility
|
IP
|
$44.69
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501034
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.99 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Health Management Network Commercial |
$37.99
|
| Rate for Payer: Health Management Network Commercial |
$20.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.26
|
| Rate for Payer: MDX Hawaii PPO |
$22.91
|
| Rate for Payer: MDX Hawaii PPO |
$43.35
|
|
|
megestrol 400 mg/10 mL susp UD [HHSC]
|
Facility
|
OP
|
$23.62
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
2501034
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.81 |
| Max. Negotiated Rate |
$22.91 |
| Rate for Payer: AlohaCare Medicaid |
$11.81
|
| Rate for Payer: AlohaCare Medicaid |
$22.34
|
| Rate for Payer: AlohaCare Medicare |
$11.81
|
| Rate for Payer: AlohaCare Medicare |
$22.34
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$15.35
|
| Rate for Payer: Devoted Health Medicare |
$12.99
|
| Rate for Payer: Devoted Health Medicare |
$24.58
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$11.81
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.44
|
| Rate for Payer: Health Management Network Commercial |
$20.08
|
| Rate for Payer: Health Management Network Commercial |
$37.99
|
| Rate for Payer: Humana Medicare |
$22.34
|
| Rate for Payer: Humana Medicare |
$11.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.22
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.05
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$11.81
|
| Rate for Payer: MDX Hawaii PPO |
$43.35
|
| Rate for Payer: MDX Hawaii PPO |
$22.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$11.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$11.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$11.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.34
|
| Rate for Payer: University Health Alliance Commercial |
$32.57
|
| Rate for Payer: University Health Alliance Commercial |
$17.22
|
|
|
melatonin 3 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
HCPCS A9150
|
| Hospital Charge Code |
2501015
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: AlohaCare Medicaid |
$1.50
|
| Rate for Payer: AlohaCare Medicare |
$1.50
|
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Devoted Health Medicare |
$1.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.85
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Humana Medicare |
$1.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.50
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
melatonin 3 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
HCPCS A9150
|
| Hospital Charge Code |
2501015
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$2.91 |
| Rate for Payer: Cash Price |
$1.95
|
| Rate for Payer: Health Management Network Commercial |
$2.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.70
|
| Rate for Payer: MDX Hawaii PPO |
$2.91
|
|
|
Meningitis/Encephalitis Panel by PCR FSI
|
Facility
|
OP
|
$516.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
8228894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$500.52 |
| Rate for Payer: AlohaCare Medicaid |
$258.00
|
| Rate for Payer: AlohaCare Medicare |
$258.00
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Devoted Health Medicare |
$283.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$48.50
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$43.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$258.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$50.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$35.09
|
| Rate for Payer: Health Management Network Commercial |
$438.60
|
| Rate for Payer: Humana Medicare |
$258.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$464.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$263.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$258.00
|
| Rate for Payer: MDX Hawaii PPO |
$500.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$258.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$258.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$48.50
|
| Rate for Payer: UnitedHealthcare Medicare |
$258.00
|
| Rate for Payer: University Health Alliance Commercial |
$90.72
|
|
|
Meningitis/Encephalitis Panel by PCR FSI
|
Facility
|
IP
|
$516.00
|
|
|
Service Code
|
HCPCS 87496
|
| Hospital Charge Code |
8228894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$500.52 |
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Health Management Network Commercial |
$438.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$464.40
|
| Rate for Payer: MDX Hawaii PPO |
$500.52
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$12,900.98
|
|
|
Service Code
|
MSDRG 760
|
| Min. Negotiated Rate |
$12,900.98 |
| Max. Negotiated Rate |
$12,900.98 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,900.98
|
|
|
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$12,900.98
|
|
|
Service Code
|
MSDRG 761
|
| Min. Negotiated Rate |
$12,900.98 |
| Max. Negotiated Rate |
$12,900.98 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$12,900.98
|
|
|
meperidine 100 mg/mL (PF) injection [HHSC]
|
Facility
|
IP
|
$19.32
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
2501187
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$18.74 |
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Health Management Network Commercial |
$16.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.39
|
| Rate for Payer: MDX Hawaii PPO |
$18.74
|
|
|
meperidine 100 mg/mL (PF) injection [HHSC]
|
Facility
|
OP
|
$19.32
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
2501187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$18.74 |
| Rate for Payer: AlohaCare Medicaid |
$9.66
|
| Rate for Payer: AlohaCare Medicare |
$9.66
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Cash Price |
$12.56
|
| Rate for Payer: Devoted Health Medicare |
$10.63
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$15.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$15.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.35
|
| Rate for Payer: Health Management Network Commercial |
$16.42
|
| Rate for Payer: Humana Medicare |
$9.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.39
|
| Rate for Payer: Kaiser Permanente Medicaid |
$9.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.66
|
| Rate for Payer: MDX Hawaii PPO |
$18.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.59
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.66
|
| Rate for Payer: University Health Alliance Commercial |
$14.08
|
|
|
Mercury, Blood FSI
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
8117991
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.26
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$92.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.03
|
|
|
Mercury, Blood FSI
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
8117991
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
Mercury Level, Urine FSI
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
8934462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$157.25 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
|
|
Mercury Level, Urine FSI
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS 83825
|
| Hospital Charge Code |
8934462
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$179.45 |
| Rate for Payer: AlohaCare Medicaid |
$92.50
|
| Rate for Payer: AlohaCare Medicare |
$92.50
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Cash Price |
$120.25
|
| Rate for Payer: Devoted Health Medicare |
$101.75
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$16.26
|
| Rate for Payer: Health Management Network Commercial |
$157.25
|
| Rate for Payer: Humana Medicare |
$92.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$166.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$94.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.50
|
| Rate for Payer: MDX Hawaii PPO |
$179.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.03
|
|
|
meropenem 1000 mg/50 mL-NS premix [HHSC]
|
Facility
|
OP
|
$168.18
|
|
|
Service Code
|
HCPCS J2184
|
| Hospital Charge Code |
2501171
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.08 |
| Max. Negotiated Rate |
$163.13 |
| Rate for Payer: AlohaCare Medicaid |
$84.09
|
| Rate for Payer: AlohaCare Medicare |
$84.09
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Devoted Health Medicare |
$92.50
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$84.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.77
|
| Rate for Payer: Health Management Network Commercial |
$142.95
|
| Rate for Payer: Humana Medicare |
$84.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$84.09
|
| Rate for Payer: MDX Hawaii PPO |
$163.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$84.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$84.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$84.09
|
| Rate for Payer: University Health Alliance Commercial |
$122.59
|
|
|
meropenem 1000 mg/50 mL-NS premix [HHSC]
|
Facility
|
IP
|
$168.18
|
|
|
Service Code
|
HCPCS J2184
|
| Hospital Charge Code |
2501171
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.95 |
| Max. Negotiated Rate |
$163.13 |
| Rate for Payer: Cash Price |
$109.32
|
| Rate for Payer: Health Management Network Commercial |
$142.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$151.36
|
| Rate for Payer: MDX Hawaii PPO |
$163.13
|
|
|
meropenem 1000 mg vial [HHSC]
|
Facility
|
OP
|
$118.47
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
2500520
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$114.92 |
| Rate for Payer: AlohaCare Medicaid |
$59.23
|
| Rate for Payer: AlohaCare Medicaid |
$36.66
|
| Rate for Payer: AlohaCare Medicaid |
$75.81
|
| Rate for Payer: AlohaCare Medicare |
$75.81
|
| Rate for Payer: AlohaCare Medicare |
$59.23
|
| Rate for Payer: AlohaCare Medicare |
$36.66
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$47.66
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$77.01
|
| Rate for Payer: Cash Price |
$77.01
|
| Rate for Payer: Cash Price |
$47.66
|
| Rate for Payer: Devoted Health Medicare |
$65.16
|
| Rate for Payer: Devoted Health Medicare |
$40.33
|
| Rate for Payer: Devoted Health Medicare |
$83.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$59.23
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$36.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$75.81
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$144.03
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$112.55
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.66
|
| Rate for Payer: Health Management Network Commercial |
$62.33
|
| Rate for Payer: Health Management Network Commercial |
$100.70
|
| Rate for Payer: Health Management Network Commercial |
$128.87
|
| Rate for Payer: Humana Medicare |
$59.23
|
| Rate for Payer: Humana Medicare |
$75.81
|
| Rate for Payer: Humana Medicare |
$36.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$77.32
|
| Rate for Payer: Kaiser Permanente Medicaid |
$60.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$59.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$75.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$36.66
|
| Rate for Payer: MDX Hawaii PPO |
$71.13
|
| Rate for Payer: MDX Hawaii PPO |
$147.06
|
| Rate for Payer: MDX Hawaii PPO |
$114.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$75.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$59.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$36.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$75.81
|
| Rate for Payer: Ohana Health Plan Medicare |
$59.23
|
| Rate for Payer: Ohana Health Plan Medicare |
$36.66
|
| Rate for Payer: UnitedHealthcare Medicaid |
$90.97
|
| Rate for Payer: UnitedHealthcare Medicaid |
$71.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$75.81
|
| Rate for Payer: UnitedHealthcare Medicare |
$59.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$36.66
|
| Rate for Payer: University Health Alliance Commercial |
$86.35
|
| Rate for Payer: University Health Alliance Commercial |
$110.51
|
| Rate for Payer: University Health Alliance Commercial |
$53.45
|
|
|
meropenem 1000 mg vial [HHSC]
|
Facility
|
IP
|
$73.33
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
2500520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$62.33 |
| Max. Negotiated Rate |
$71.13 |
| Rate for Payer: Cash Price |
$47.66
|
| Rate for Payer: Cash Price |
$98.55
|
| Rate for Payer: Cash Price |
$77.01
|
| Rate for Payer: Health Management Network Commercial |
$100.70
|
| Rate for Payer: Health Management Network Commercial |
$62.33
|
| Rate for Payer: Health Management Network Commercial |
$128.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$136.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$106.62
|
| Rate for Payer: MDX Hawaii PPO |
$147.06
|
| Rate for Payer: MDX Hawaii PPO |
$114.92
|
| Rate for Payer: MDX Hawaii PPO |
$71.13
|
|
|
meropenem 500 mg vial [HHSC]
|
Facility
|
IP
|
$68.31
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
2500521
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.06 |
| Max. Negotiated Rate |
$66.26 |
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Health Management Network Commercial |
$58.06
|
| Rate for Payer: Health Management Network Commercial |
$77.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.02
|
| Rate for Payer: MDX Hawaii PPO |
$88.40
|
| Rate for Payer: MDX Hawaii PPO |
$66.26
|
|
|
meropenem 500 mg vial [HHSC]
|
Facility
|
OP
|
$68.31
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
2500521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$66.26 |
| Rate for Payer: AlohaCare Medicaid |
$34.16
|
| Rate for Payer: AlohaCare Medicaid |
$45.56
|
| Rate for Payer: AlohaCare Medicare |
$45.56
|
| Rate for Payer: AlohaCare Medicare |
$34.16
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$59.23
|
| Rate for Payer: Devoted Health Medicare |
$37.57
|
| Rate for Payer: Devoted Health Medicare |
$50.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.16
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.44
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$64.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$86.57
|
| Rate for Payer: Health Management Network Commercial |
$77.46
|
| Rate for Payer: Health Management Network Commercial |
$58.06
|
| Rate for Payer: Humana Medicare |
$34.16
|
| Rate for Payer: Humana Medicare |
$45.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$61.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$82.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$46.48
|
| Rate for Payer: Kaiser Permanente Medicaid |
$34.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.56
|
| Rate for Payer: MDX Hawaii PPO |
$66.26
|
| Rate for Payer: MDX Hawaii PPO |
$88.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$54.68
|
| Rate for Payer: UnitedHealthcare Medicaid |
$40.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.56
|
| Rate for Payer: University Health Alliance Commercial |
$49.79
|
| Rate for Payer: University Health Alliance Commercial |
$66.42
|
|
|
MESH, PERFIX PLUG LARGE
|
Facility
|
IP
|
$1,097.00
|
|
|
Service Code
|
HCPCS C1781
|
| Hospital Charge Code |
8274198
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.32 |
| Max. Negotiated Rate |
$1,064.09 |
| Rate for Payer: Cash Price |
$713.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$767.90
|
| Rate for Payer: Health Management Network Commercial |
$932.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$987.30
|
| Rate for Payer: MDX Hawaii PPO |
$1,064.09
|
| Rate for Payer: University Health Alliance Commercial |
$614.32
|
|
