|
ATHEROSCLEROSIS WITHOUT MCC
|
Facility
|
IP
|
$14,078.99
|
|
|
Service Code
|
MSDRG 303
|
| Min. Negotiated Rate |
$14,078.99 |
| Max. Negotiated Rate |
$14,078.99 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,078.99
|
|
|
ATORVASTATIN 10 MG PO TABLET
|
Facility
|
OP
|
$3.49
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: AlohaCare Medicaid |
$1.75
|
| Rate for Payer: AlohaCare Medicare |
$3.14
|
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Devoted Health Medicare |
$3.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.32
|
| Rate for Payer: Health Management Network Commercial |
$2.97
|
| Rate for Payer: Humana Medicare |
$3.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.78
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.14
|
| Rate for Payer: MDX Hawaii PPO |
$3.39
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.14
|
| Rate for Payer: University Health Alliance Commercial |
$2.54
|
|
|
ATORVASTATIN 10 MG PO TABLET
|
Facility
|
IP
|
$3.49
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$3.39 |
| Rate for Payer: Cash Price |
$2.27
|
| Rate for Payer: Health Management Network Commercial |
$2.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.14
|
| Rate for Payer: MDX Hawaii PPO |
$3.39
|
|
|
ATORVASTATIN 20 MG PO TABLET
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Health Management Network Commercial |
$4.03
|
| Rate for Payer: Health Management Network Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.61
|
| Rate for Payer: MDX Hawaii PPO |
$2.81
|
| Rate for Payer: MDX Hawaii PPO |
$4.60
|
|
|
ATORVASTATIN 20 MG PO TABLET
|
Facility
|
OP
|
$2.90
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: AlohaCare Medicaid |
$1.45
|
| Rate for Payer: AlohaCare Medicaid |
$2.37
|
| Rate for Payer: AlohaCare Medicare |
$2.61
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Devoted Health Medicare |
$2.87
|
| Rate for Payer: Devoted Health Medicare |
$4.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.50
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.75
|
| Rate for Payer: Health Management Network Commercial |
$2.46
|
| Rate for Payer: Health Management Network Commercial |
$4.03
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Humana Medicare |
$2.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.42
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.48
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.61
|
| Rate for Payer: MDX Hawaii PPO |
$4.60
|
| Rate for Payer: MDX Hawaii PPO |
$2.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
| Rate for Payer: University Health Alliance Commercial |
$3.45
|
| Rate for Payer: University Health Alliance Commercial |
$2.11
|
|
|
ATORVASTATIN 40 MG PO TABLET
|
Facility
|
OP
|
$4.74
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$4.69 |
| Rate for Payer: AlohaCare Medicaid |
$2.37
|
| Rate for Payer: AlohaCare Medicare |
$4.27
|
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Devoted Health Medicare |
$4.69
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$4.27
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$4.50
|
| Rate for Payer: Health Management Network Commercial |
$4.03
|
| Rate for Payer: Humana Medicare |
$4.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.42
|
| Rate for Payer: Kaiser Permanente Medicare |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$4.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$4.27
|
| Rate for Payer: Ohana Health Plan Medicare |
$4.27
|
| Rate for Payer: UnitedHealthcare Medicare |
$4.27
|
| Rate for Payer: University Health Alliance Commercial |
$3.45
|
|
|
ATORVASTATIN 40 MG PO TABLET
|
Facility
|
IP
|
$4.74
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.03 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Cash Price |
$3.08
|
| Rate for Payer: Health Management Network Commercial |
$4.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$4.27
|
| Rate for Payer: MDX Hawaii PPO |
$4.60
|
|
|
ATROPINE 0.1 MG/ML INJ SYR
|
Facility
|
OP
|
$65.41
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$64.76 |
| Rate for Payer: AlohaCare Medicaid |
$32.70
|
| Rate for Payer: AlohaCare Medicare |
$58.87
|
| Rate for Payer: Cash Price |
$42.52
|
| Rate for Payer: Cash Price |
$42.52
|
| Rate for Payer: Devoted Health Medicare |
$64.76
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.87
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$62.14
|
| Rate for Payer: Health Management Network Commercial |
$55.60
|
| Rate for Payer: Humana Medicare |
$58.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$33.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.87
|
| Rate for Payer: MDX Hawaii PPO |
$63.45
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.87
|
| Rate for Payer: UnitedHealthcare Medicaid |
$39.25
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.87
|
| Rate for Payer: University Health Alliance Commercial |
$47.68
|
|
|
ATROPINE 0.1 MG/ML INJ SYR
|
Facility
|
IP
|
$65.41
|
|
|
Service Code
|
HCPCS J0461
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$63.45 |
| Rate for Payer: Cash Price |
$42.52
|
| Rate for Payer: Health Management Network Commercial |
$55.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.87
|
| Rate for Payer: MDX Hawaii PPO |
$63.45
|
|
|
ATROPINE 0.4 MG/ML IV SOLN
|
Facility
|
OP
|
$64.50
|
|
|
Service Code
|
HCPCS J0462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$63.85 |
| Rate for Payer: AlohaCare Medicaid |
$32.25
|
| Rate for Payer: AlohaCare Medicare |
$58.05
|
| Rate for Payer: Cash Price |
$41.92
|
| Rate for Payer: Devoted Health Medicare |
$63.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$58.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$61.27
|
| Rate for Payer: Health Management Network Commercial |
$54.83
|
| Rate for Payer: Humana Medicare |
$58.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.05
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$58.05
|
| Rate for Payer: MDX Hawaii PPO |
$62.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$58.05
|
| Rate for Payer: Ohana Health Plan Medicare |
$58.05
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.70
|
| Rate for Payer: UnitedHealthcare Medicare |
$58.05
|
| Rate for Payer: University Health Alliance Commercial |
$47.01
|
|
|
ATROPINE 0.4 MG/ML IV SOLN
|
Facility
|
IP
|
$64.50
|
|
|
Service Code
|
HCPCS J0462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.83 |
| Max. Negotiated Rate |
$62.56 |
| Rate for Payer: Cash Price |
$41.92
|
| Rate for Payer: Health Management Network Commercial |
$54.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$58.05
|
| Rate for Payer: MDX Hawaii PPO |
$62.56
|
|
|
ATROPINE 1 MG/ML IV SOLN
|
Facility
|
IP
|
$88.22
|
|
|
Service Code
|
HCPCS J0462
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.99 |
| Max. Negotiated Rate |
$85.57 |
| Rate for Payer: Cash Price |
$57.34
|
| Rate for Payer: Health Management Network Commercial |
$74.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.40
|
| Rate for Payer: MDX Hawaii PPO |
$85.57
|
|
|
ATROPINE 1 MG/ML IV SOLN
|
Facility
|
OP
|
$88.22
|
|
|
Service Code
|
HCPCS J0462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.11 |
| Max. Negotiated Rate |
$87.34 |
| Rate for Payer: AlohaCare Medicaid |
$44.11
|
| Rate for Payer: AlohaCare Medicare |
$79.40
|
| Rate for Payer: Cash Price |
$57.34
|
| Rate for Payer: Devoted Health Medicare |
$87.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.81
|
| Rate for Payer: Health Management Network Commercial |
$74.99
|
| Rate for Payer: Humana Medicare |
$79.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.40
|
| Rate for Payer: MDX Hawaii PPO |
$85.57
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.40
|
| Rate for Payer: University Health Alliance Commercial |
$64.30
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC
|
Facility
|
IP
|
$228,961.32
|
|
|
Service Code
|
MSDRG 016
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$228,961.32 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228,961.32
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC
|
Facility
|
IP
|
$228,961.32
|
|
|
Service Code
|
MSDRG 017
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$228,961.32 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$228,961.32
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
AZITHROMYCIN 100 MG/5 ML PO SUSR
|
Facility
|
IP
|
$162.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.03 |
| Max. Negotiated Rate |
$157.52 |
| Rate for Payer: Cash Price |
$105.55
|
| Rate for Payer: Health Management Network Commercial |
$138.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.15
|
| Rate for Payer: MDX Hawaii PPO |
$157.52
|
|
|
AZITHROMYCIN 100 MG/5 ML PO SUSR
|
Facility
|
OP
|
$162.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.19 |
| Max. Negotiated Rate |
$160.77 |
| Rate for Payer: AlohaCare Medicaid |
$81.19
|
| Rate for Payer: AlohaCare Medicare |
$146.15
|
| Rate for Payer: Cash Price |
$105.55
|
| Rate for Payer: Devoted Health Medicare |
$160.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.27
|
| Rate for Payer: Health Management Network Commercial |
$138.03
|
| Rate for Payer: Humana Medicare |
$146.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.15
|
| Rate for Payer: MDX Hawaii PPO |
$157.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.15
|
| Rate for Payer: University Health Alliance Commercial |
$118.37
|
|
|
AZITHROMYCIN 200 MG/5 ML PO SUSR
|
Facility
|
OP
|
$162.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$81.19 |
| Max. Negotiated Rate |
$160.77 |
| Rate for Payer: AlohaCare Medicaid |
$81.19
|
| Rate for Payer: AlohaCare Medicare |
$146.15
|
| Rate for Payer: Cash Price |
$105.55
|
| Rate for Payer: Devoted Health Medicare |
$160.77
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$146.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$154.27
|
| Rate for Payer: Health Management Network Commercial |
$138.03
|
| Rate for Payer: Humana Medicare |
$146.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$82.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$146.15
|
| Rate for Payer: MDX Hawaii PPO |
$157.52
|
| Rate for Payer: Ohana Health Plan Medicaid |
$146.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$146.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$146.15
|
| Rate for Payer: University Health Alliance Commercial |
$118.37
|
|
|
AZITHROMYCIN 200 MG/5 ML PO SUSR
|
Facility
|
IP
|
$162.39
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$138.03 |
| Max. Negotiated Rate |
$157.52 |
| Rate for Payer: Cash Price |
$105.55
|
| Rate for Payer: Health Management Network Commercial |
$138.03
|
| Rate for Payer: Kaiser Permanente Commercial |
$146.15
|
| Rate for Payer: MDX Hawaii PPO |
$157.52
|
|
|
AZITHROMYCIN 250 MG PO TABLET
|
Facility
|
OP
|
$23.27
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.63 |
| Max. Negotiated Rate |
$23.04 |
| Rate for Payer: AlohaCare Medicaid |
$11.63
|
| Rate for Payer: AlohaCare Medicaid |
$5.17
|
| Rate for Payer: AlohaCare Medicaid |
$5.79
|
| Rate for Payer: AlohaCare Medicare |
$9.31
|
| Rate for Payer: AlohaCare Medicare |
$20.94
|
| Rate for Payer: AlohaCare Medicare |
$10.41
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Cash Price |
$15.13
|
| Rate for Payer: Devoted Health Medicare |
$11.45
|
| Rate for Payer: Devoted Health Medicare |
$10.24
|
| Rate for Payer: Devoted Health Medicare |
$23.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.31
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.94
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.99
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.82
|
| Rate for Payer: Health Management Network Commercial |
$8.79
|
| Rate for Payer: Health Management Network Commercial |
$19.78
|
| Rate for Payer: Health Management Network Commercial |
$9.83
|
| Rate for Payer: Humana Medicare |
$9.31
|
| Rate for Payer: Humana Medicare |
$10.41
|
| Rate for Payer: Humana Medicare |
$20.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.27
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.90
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.31
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.94
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.41
|
| Rate for Payer: MDX Hawaii PPO |
$22.57
|
| Rate for Payer: MDX Hawaii PPO |
$11.22
|
| Rate for Payer: MDX Hawaii PPO |
$10.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.41
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.94
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.31
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.41
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.94
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.31
|
| Rate for Payer: University Health Alliance Commercial |
$16.96
|
| Rate for Payer: University Health Alliance Commercial |
$7.54
|
| Rate for Payer: University Health Alliance Commercial |
$8.43
|
|
|
AZITHROMYCIN 250 MG PO TABLET
|
Facility
|
IP
|
$23.27
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.78 |
| Max. Negotiated Rate |
$22.57 |
| Rate for Payer: Cash Price |
$15.13
|
| Rate for Payer: Cash Price |
$7.52
|
| Rate for Payer: Cash Price |
$6.72
|
| Rate for Payer: Health Management Network Commercial |
$19.78
|
| Rate for Payer: Health Management Network Commercial |
$8.79
|
| Rate for Payer: Health Management Network Commercial |
$9.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.31
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.94
|
| Rate for Payer: MDX Hawaii PPO |
$11.22
|
| Rate for Payer: MDX Hawaii PPO |
$10.03
|
| Rate for Payer: MDX Hawaii PPO |
$22.57
|
|
|
AZITHROMYCIN 500 MG IV RECON.SOLN.
|
Facility
|
IP
|
$45.54
|
|
|
Service Code
|
HCPCS J0456
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$44.17 |
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Health Management Network Commercial |
$38.71
|
| Rate for Payer: Health Management Network Commercial |
$54.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.19
|
| Rate for Payer: MDX Hawaii PPO |
$61.63
|
| Rate for Payer: MDX Hawaii PPO |
$44.17
|
|
|
AZITHROMYCIN 500 MG IV RECON.SOLN.
|
Facility
|
OP
|
$45.54
|
|
|
Service Code
|
HCPCS J0456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: AlohaCare Medicaid |
$22.77
|
| Rate for Payer: AlohaCare Medicaid |
$31.77
|
| Rate for Payer: AlohaCare Medicare |
$57.19
|
| Rate for Payer: AlohaCare Medicare |
$40.99
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$41.30
|
| Rate for Payer: Devoted Health Medicare |
$45.08
|
| Rate for Payer: Devoted Health Medicare |
$62.90
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$57.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.61
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$60.36
|
| Rate for Payer: Health Management Network Commercial |
$54.01
|
| Rate for Payer: Health Management Network Commercial |
$38.71
|
| Rate for Payer: Humana Medicare |
$40.99
|
| Rate for Payer: Humana Medicare |
$57.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$57.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$32.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.23
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.99
|
| Rate for Payer: Kaiser Permanente Medicare |
$57.19
|
| Rate for Payer: MDX Hawaii PPO |
$44.17
|
| Rate for Payer: MDX Hawaii PPO |
$61.63
|
| Rate for Payer: Ohana Health Plan Medicaid |
$57.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$57.19
|
| Rate for Payer: UnitedHealthcare Medicaid |
$38.12
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.32
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.99
|
| Rate for Payer: UnitedHealthcare Medicare |
$57.19
|
| Rate for Payer: University Health Alliance Commercial |
$33.19
|
| Rate for Payer: University Health Alliance Commercial |
$46.31
|
|
|
AZTREONAM 1 GRAM INJ RECON.SOLN.
|
Facility
|
OP
|
$141.07
|
|
|
Service Code
|
HCPCS J0457
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$139.66 |
| Rate for Payer: AlohaCare Medicaid |
$70.53
|
| Rate for Payer: AlohaCare Medicaid |
$83.69
|
| Rate for Payer: AlohaCare Medicare |
$150.64
|
| Rate for Payer: AlohaCare Medicare |
$126.96
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Devoted Health Medicare |
$139.66
|
| Rate for Payer: Devoted Health Medicare |
$165.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.67
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$150.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$126.96
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.67
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$134.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$159.01
|
| Rate for Payer: Health Management Network Commercial |
$142.27
|
| Rate for Payer: Health Management Network Commercial |
$119.91
|
| Rate for Payer: Humana Medicare |
$126.96
|
| Rate for Payer: Humana Medicare |
$150.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$85.36
|
| Rate for Payer: Kaiser Permanente Medicaid |
$71.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$126.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$150.64
|
| Rate for Payer: MDX Hawaii PPO |
$136.84
|
| Rate for Payer: MDX Hawaii PPO |
$162.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$150.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$126.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$126.96
|
| Rate for Payer: Ohana Health Plan Medicare |
$150.64
|
| Rate for Payer: UnitedHealthcare Medicaid |
$100.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$84.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$126.96
|
| Rate for Payer: UnitedHealthcare Medicare |
$150.64
|
| Rate for Payer: University Health Alliance Commercial |
$102.83
|
| Rate for Payer: University Health Alliance Commercial |
$122.00
|
|
|
AZTREONAM 1 GRAM INJ RECON.SOLN.
|
Facility
|
IP
|
$141.07
|
|
|
Service Code
|
HCPCS J0457
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$119.91 |
| Max. Negotiated Rate |
$136.84 |
| Rate for Payer: Cash Price |
$91.70
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Health Management Network Commercial |
$119.91
|
| Rate for Payer: Health Management Network Commercial |
$142.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$126.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$150.64
|
| Rate for Payer: MDX Hawaii PPO |
$162.36
|
| Rate for Payer: MDX Hawaii PPO |
$136.84
|
|
