|
Methadone, Clinical Urine
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
12516232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$118.15 |
| Max. Negotiated Rate |
$134.83 |
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
|
|
Methadone, Clinical Urine
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
12516232
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$147.65 |
| Rate for Payer: AlohaCare Medicaid |
$69.50
|
| Rate for Payer: AlohaCare Medicare |
$69.50
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Cash Price |
$90.35
|
| Rate for Payer: Devoted Health Medicare |
$76.45
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$69.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$118.15
|
| Rate for Payer: Humana Medicare |
$69.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$125.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$70.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$69.50
|
| Rate for Payer: MDX Hawaii PPO |
$134.83
|
| Rate for Payer: Ohana Health Plan Medicaid |
$69.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$69.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$69.50
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
.Methadone, Ur Cnfrm FSI
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS 80358
|
| Hospital Charge Code |
8729565
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.67 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: AlohaCare Medicaid |
$100.00
|
| Rate for Payer: AlohaCare Medicare |
$100.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Devoted Health Medicare |
$110.00
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$21.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$100.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$190.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Humana Medicare |
$100.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$102.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$100.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
| Rate for Payer: Ohana Health Plan Medicaid |
$100.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$100.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$100.00
|
| Rate for Payer: University Health Alliance Commercial |
$145.78
|
|
|
.Methadone, Ur Cnfrm FSI
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS 80358
|
| Hospital Charge Code |
8729565
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$194.00 |
| Rate for Payer: Cash Price |
$130.00
|
| Rate for Payer: Health Management Network Commercial |
$170.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$180.00
|
| Rate for Payer: MDX Hawaii PPO |
$194.00
|
|
|
Methadone Urine Screen FSI
|
Facility
|
OP
|
$1,384.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
8228895
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.89 |
| Max. Negotiated Rate |
$1,342.48 |
| Rate for Payer: AlohaCare Medicaid |
$692.00
|
| Rate for Payer: AlohaCare Medicare |
$692.00
|
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Devoted Health Medicare |
$761.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.38
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$77.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$692.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.38
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$1,176.40
|
| Rate for Payer: Humana Medicare |
$692.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,245.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$705.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$692.00
|
| Rate for Payer: MDX Hawaii PPO |
$1,342.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$692.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$692.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$47.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$692.00
|
| Rate for Payer: University Health Alliance Commercial |
$147.65
|
|
|
Methadone Urine Screen FSI
|
Facility
|
IP
|
$1,384.00
|
|
|
Service Code
|
HCPCS 80307
|
| Hospital Charge Code |
8228895
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1,176.40 |
| Max. Negotiated Rate |
$1,342.48 |
| Rate for Payer: Cash Price |
$899.60
|
| Rate for Payer: Health Management Network Commercial |
$1,176.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,245.60
|
| Rate for Payer: MDX Hawaii PPO |
$1,342.48
|
|
|
.Methaqualone, Ur Cnfrm FSI
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
8729404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$482.80 |
| Max. Negotiated Rate |
$550.96 |
| Rate for Payer: Cash Price |
$369.20
|
| Rate for Payer: Health Management Network Commercial |
$482.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$511.20
|
| Rate for Payer: MDX Hawaii PPO |
$550.96
|
|
|
.Methaqualone, Ur Cnfrm FSI
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
HCPCS 80375
|
| Hospital Charge Code |
8729404
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.66 |
| Max. Negotiated Rate |
$550.96 |
| Rate for Payer: AlohaCare Medicaid |
$284.00
|
| Rate for Payer: AlohaCare Medicare |
$284.00
|
| Rate for Payer: Cash Price |
$369.20
|
| Rate for Payer: Cash Price |
$369.20
|
| Rate for Payer: Devoted Health Medicare |
$312.40
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.66
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$284.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$539.60
|
| Rate for Payer: Health Management Network Commercial |
$482.80
|
| Rate for Payer: Humana Medicare |
$284.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$511.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$289.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$284.00
|
| Rate for Payer: MDX Hawaii PPO |
$550.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$284.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$284.00
|
| Rate for Payer: UnitedHealthcare Medicare |
$284.00
|
| Rate for Payer: University Health Alliance Commercial |
$414.02
|
|
|
methocarbamol 500 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
2501167
|
|
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
|
|
|
methocarbamol 500 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687055901
|
| Hospital Charge Code |
2501167
|
|
Hospital Revenue Code
|
250
|
| 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 Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
methocarbamol 750 mg tablet [HHSC]
|
Facility
|
OP
|
$3.00
|
|
|
Service Code
|
NDC 60687056801
|
| Hospital Charge Code |
2501168
|
|
Hospital Revenue Code
|
250
|
| 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 Medicaid |
$1.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.50
|
| Rate for Payer: University Health Alliance Commercial |
$2.19
|
|
|
methocarbamol 750 mg tablet [HHSC]
|
Facility
|
IP
|
$3.00
|
|
|
Service Code
|
NDC 60687056801
|
| Hospital Charge Code |
2501168
|
|
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
|
|
|
methotrexate 50 mg/2 mL vial [HHSC]
|
Facility
|
IP
|
$52.15
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
2501156
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.33 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Health Management Network Commercial |
$44.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.94
|
| Rate for Payer: MDX Hawaii PPO |
$50.59
|
|
|
methotrexate 50 mg/2 mL vial [HHSC]
|
Facility
|
OP
|
$52.15
|
|
|
Service Code
|
HCPCS J9260
|
| Hospital Charge Code |
2501156
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$50.59 |
| Rate for Payer: AlohaCare Medicaid |
$26.07
|
| Rate for Payer: AlohaCare Medicare |
$26.07
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Devoted Health Medicare |
$28.68
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.26
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.07
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$49.54
|
| Rate for Payer: Health Management Network Commercial |
$44.33
|
| Rate for Payer: Humana Medicare |
$26.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$46.94
|
| Rate for Payer: Kaiser Permanente Medicaid |
$26.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.07
|
| Rate for Payer: MDX Hawaii PPO |
$50.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.07
|
| Rate for Payer: University Health Alliance Commercial |
$38.01
|
|
|
Methotrexate FSI
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
8404552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: AlohaCare Medicaid |
$78.50
|
| Rate for Payer: AlohaCare Medicare |
$78.50
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Devoted Health Medicare |
$86.35
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$18.92
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$23.30
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.64
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Humana Medicare |
$78.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.07
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.50
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$18.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.50
|
| Rate for Payer: University Health Alliance Commercial |
$35.39
|
|
|
Methotrexate FSI
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS 80299
|
| Hospital Charge Code |
8404552
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$133.45 |
| Max. Negotiated Rate |
$152.29 |
| Rate for Payer: Cash Price |
$102.05
|
| Rate for Payer: Health Management Network Commercial |
$133.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$141.30
|
| Rate for Payer: MDX Hawaii PPO |
$152.29
|
|
|
methylene blue (0.5%) 50 mg/10 mL amp [HHSC]
|
Facility
|
OP
|
$895.16
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
2501106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$447.58 |
| Max. Negotiated Rate |
$868.31 |
| Rate for Payer: AlohaCare Medicaid |
$447.58
|
| Rate for Payer: AlohaCare Medicare |
$447.58
|
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: Devoted Health Medicare |
$492.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$447.58
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$850.40
|
| Rate for Payer: Health Management Network Commercial |
$760.89
|
| Rate for Payer: Humana Medicare |
$447.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$805.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$456.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$447.58
|
| Rate for Payer: MDX Hawaii PPO |
$868.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$447.58
|
| Rate for Payer: Ohana Health Plan Medicare |
$447.58
|
| Rate for Payer: UnitedHealthcare Medicaid |
$537.10
|
| Rate for Payer: UnitedHealthcare Medicare |
$447.58
|
| Rate for Payer: University Health Alliance Commercial |
$652.48
|
|
|
methylene blue (0.5%) 50 mg/10 mL amp [HHSC]
|
Facility
|
IP
|
$895.16
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
2501106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$760.89 |
| Max. Negotiated Rate |
$868.31 |
| Rate for Payer: Cash Price |
$581.85
|
| Rate for Payer: Health Management Network Commercial |
$760.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$805.64
|
| Rate for Payer: MDX Hawaii PPO |
$868.31
|
|
|
methylene blue (0.5%) 50 mg/10 mL amp [HHSC]
|
Facility
|
IP
|
$829.85
|
|
|
Service Code
|
NDC 00517038105
|
| Hospital Charge Code |
2501106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$705.37 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Health Management Network Commercial |
$705.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$746.87
|
| Rate for Payer: MDX Hawaii PPO |
$804.95
|
|
|
methylene blue (0.5%) 50 mg/10 mL amp [HHSC]
|
Facility
|
OP
|
$829.85
|
|
|
Service Code
|
NDC 00517038105
|
| Hospital Charge Code |
2501106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$414.93 |
| Max. Negotiated Rate |
$804.95 |
| Rate for Payer: AlohaCare Medicaid |
$414.93
|
| Rate for Payer: AlohaCare Medicare |
$414.93
|
| Rate for Payer: Cash Price |
$539.40
|
| Rate for Payer: Devoted Health Medicare |
$456.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$414.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$788.36
|
| Rate for Payer: Health Management Network Commercial |
$705.37
|
| Rate for Payer: Humana Medicare |
$414.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$746.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$423.22
|
| Rate for Payer: Kaiser Permanente Medicare |
$414.93
|
| Rate for Payer: MDX Hawaii PPO |
$804.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$414.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$414.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$497.91
|
| Rate for Payer: UnitedHealthcare Medicare |
$414.93
|
| Rate for Payer: University Health Alliance Commercial |
$604.88
|
|
|
methylergonovine 0.2 mg/1ml inj [HHSC]
|
Facility
|
OP
|
$147.21
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
2500529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.06 |
| Max. Negotiated Rate |
$142.79 |
| Rate for Payer: AlohaCare Medicaid |
$73.61
|
| Rate for Payer: AlohaCare Medicaid |
$58.63
|
| Rate for Payer: AlohaCare Medicare |
$58.63
|
| Rate for Payer: AlohaCare Medicare |
$73.61
|
| Rate for Payer: Cash Price |
$95.69
|
| Rate for Payer: Cash Price |
$76.23
|
| Rate for Payer: Cash Price |
$95.69
|
| Rate for Payer: Cash Price |
$76.23
|
| Rate for Payer: Devoted Health Medicare |
$64.50
|
| Rate for Payer: Devoted Health Medicare |
$80.97
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$73.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.63
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.06
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$111.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$139.85
|
| Rate for Payer: Health Management Network Commercial |
$125.13
|
| Rate for Payer: Health Management Network Commercial |
$99.68
|
| Rate for Payer: Humana Medicare |
$73.61
|
| Rate for Payer: Humana Medicare |
$58.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$59.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$75.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$73.61
|
| Rate for Payer: MDX Hawaii PPO |
$142.79
|
| Rate for Payer: MDX Hawaii PPO |
$113.75
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$73.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$73.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$70.36
|
| Rate for Payer: UnitedHealthcare Medicaid |
$88.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$73.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.63
|
| Rate for Payer: University Health Alliance Commercial |
$107.30
|
| Rate for Payer: University Health Alliance Commercial |
$85.48
|
|
|
methylergonovine 0.2 mg/1ml inj [HHSC]
|
Facility
|
IP
|
$147.21
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
2500529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.13 |
| Max. Negotiated Rate |
$142.79 |
| Rate for Payer: Cash Price |
$95.69
|
| Rate for Payer: Cash Price |
$76.23
|
| Rate for Payer: Health Management Network Commercial |
$125.13
|
| Rate for Payer: Health Management Network Commercial |
$99.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$105.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$132.49
|
| Rate for Payer: MDX Hawaii PPO |
$113.75
|
| Rate for Payer: MDX Hawaii PPO |
$142.79
|
|
|
Methyl Ethyl Ketones FSI
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
8228897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.47 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: AlohaCare Medicaid |
$92.00
|
| Rate for Payer: AlohaCare Medicare |
$92.00
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Devoted Health Medicare |
$101.20
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$13.47
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21.39
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$92.00
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$22.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$17.11
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Humana Medicare |
$92.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.84
|
| Rate for Payer: Kaiser Permanente Medicare |
$92.00
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$92.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$92.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$92.00
|
| Rate for Payer: University Health Alliance Commercial |
$41.53
|
|
|
Methyl Ethyl Ketones FSI
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
HCPCS 84600
|
| Hospital Charge Code |
8228897
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Cash Price |
$119.60
|
| Rate for Payer: Health Management Network Commercial |
$156.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.60
|
| Rate for Payer: MDX Hawaii PPO |
$178.48
|
|
|
Methylmalonic Acid Quantitative FSI
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
HCPCS 83921
|
| Hospital Charge Code |
8117994
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.21 |
| Max. Negotiated Rate |
$99.91 |
| Rate for Payer: AlohaCare Medicaid |
$51.50
|
| Rate for Payer: AlohaCare Medicare |
$51.50
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Cash Price |
$66.95
|
| Rate for Payer: Devoted Health Medicare |
$56.65
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$22.75
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$26.51
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.50
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$23.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.21
|
| Rate for Payer: Health Management Network Commercial |
$87.55
|
| Rate for Payer: Humana Medicare |
$51.50
|
| Rate for Payer: Kaiser Permanente Commercial |
$92.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$52.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.50
|
| Rate for Payer: MDX Hawaii PPO |
$99.91
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.50
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.50
|
| Rate for Payer: UnitedHealthcare Medicaid |
$22.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.50
|
| Rate for Payer: University Health Alliance Commercial |
$42.55
|
|
