|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN
|
Facility
|
IP
|
$44.57
|
|
|
Service Code
|
NDC 00409428202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.88 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN
|
Facility
|
IP
|
$44.57
|
|
|
Service Code
|
NDC 00409428212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.88 |
| Max. Negotiated Rate |
$43.23 |
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN
|
Facility
|
OP
|
$44.57
|
|
|
Service Code
|
NDC 00409428212
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$44.12 |
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicare |
$40.11
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Devoted Health Medicare |
$44.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.34
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Humana Medicare |
$40.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.11
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.11
|
| Rate for Payer: University Health Alliance Commercial |
$32.49
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN
|
Facility
|
OP
|
$44.57
|
|
|
Service Code
|
NDC 00409428202
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.29 |
| Max. Negotiated Rate |
$44.12 |
| Rate for Payer: AlohaCare Medicaid |
$22.29
|
| Rate for Payer: AlohaCare Medicare |
$40.11
|
| Rate for Payer: Cash Price |
$28.97
|
| Rate for Payer: Devoted Health Medicare |
$44.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.34
|
| Rate for Payer: Health Management Network Commercial |
$37.88
|
| Rate for Payer: Humana Medicare |
$40.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.11
|
| Rate for Payer: MDX Hawaii PPO |
$43.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.11
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.74
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.11
|
| Rate for Payer: University Health Alliance Commercial |
$32.49
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN (2ML)
|
Facility
|
OP
|
$11.77
|
|
|
Service Code
|
NDC 00409428201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: AlohaCare Medicaid |
$5.88
|
| Rate for Payer: AlohaCare Medicare |
$10.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Devoted Health Medicare |
$11.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.18
|
| Rate for Payer: Health Management Network Commercial |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.59
|
| Rate for Payer: MDX Hawaii PPO |
$11.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.59
|
| Rate for Payer: University Health Alliance Commercial |
$8.58
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN (2ML)
|
Facility
|
IP
|
$11.77
|
|
|
Service Code
|
NDC 00409428201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Health Management Network Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.59
|
| Rate for Payer: MDX Hawaii PPO |
$11.42
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN (2ML)
|
Facility
|
IP
|
$11.77
|
|
|
Service Code
|
NDC 00409428211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$11.42 |
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Health Management Network Commercial |
$10.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.59
|
| Rate for Payer: MDX Hawaii PPO |
$11.42
|
|
|
LIDOCAINE HCL (PF) 2% (20 MG/ML) INJ SOLN (2ML)
|
Facility
|
OP
|
$11.77
|
|
|
Service Code
|
NDC 00409428211
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.65 |
| Rate for Payer: AlohaCare Medicaid |
$5.88
|
| Rate for Payer: AlohaCare Medicare |
$10.59
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Devoted Health Medicare |
$11.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.59
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.18
|
| Rate for Payer: Health Management Network Commercial |
$10.00
|
| Rate for Payer: Humana Medicare |
$10.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.59
|
| Rate for Payer: Kaiser Permanente Medicaid |
$6.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.59
|
| Rate for Payer: MDX Hawaii PPO |
$11.42
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.59
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.59
|
| Rate for Payer: UnitedHealthcare Medicaid |
$7.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.59
|
| Rate for Payer: University Health Alliance Commercial |
$8.58
|
|
|
LIDOCAINE IN 5 % DEXTROSE (PF) 4 MG/ML (0.4 %) IV SOLP
|
Facility
|
IP
|
$48.29
|
|
|
Service Code
|
HCPCS J2002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$46.84 |
| Rate for Payer: Cash Price |
$31.39
|
| Rate for Payer: Health Management Network Commercial |
$41.05
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.46
|
| Rate for Payer: MDX Hawaii PPO |
$46.84
|
|
|
LIDOCAINE IN 5 % DEXTROSE (PF) 4 MG/ML (0.4 %) IV SOLP
|
Facility
|
OP
|
$48.29
|
|
|
Service Code
|
HCPCS J2002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: AlohaCare Medicaid |
$24.14
|
| Rate for Payer: AlohaCare Medicare |
$43.46
|
| Rate for Payer: Cash Price |
$31.39
|
| Rate for Payer: Cash Price |
$31.39
|
| Rate for Payer: Devoted Health Medicare |
$47.81
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.46
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$45.88
|
| Rate for Payer: Health Management Network Commercial |
$41.05
|
| Rate for Payer: Humana Medicare |
$43.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.63
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.46
|
| Rate for Payer: MDX Hawaii PPO |
$46.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.46
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.97
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.46
|
| Rate for Payer: University Health Alliance Commercial |
$35.20
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYR
|
Facility
|
IP
|
$52.94
|
|
|
Service Code
|
NDC 76329339001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$51.35 |
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Health Management Network Commercial |
$45.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.65
|
| Rate for Payer: MDX Hawaii PPO |
$51.35
|
|
|
LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYR
|
Facility
|
OP
|
$52.94
|
|
|
Service Code
|
NDC 76329339001
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.47 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: AlohaCare Medicaid |
$26.47
|
| Rate for Payer: AlohaCare Medicare |
$47.65
|
| Rate for Payer: Cash Price |
$34.41
|
| Rate for Payer: Devoted Health Medicare |
$52.41
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.29
|
| Rate for Payer: Health Management Network Commercial |
$45.00
|
| Rate for Payer: Humana Medicare |
$47.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.65
|
| Rate for Payer: MDX Hawaii PPO |
$51.35
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.65
|
| Rate for Payer: University Health Alliance Commercial |
$38.59
|
|
|
LIDOCAINE (PF) 3.5 % OPHT GEL
|
Facility
|
IP
|
$114.72
|
|
|
Service Code
|
NDC 82584079201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$111.28 |
| Rate for Payer: Cash Price |
$74.57
|
| Rate for Payer: Health Management Network Commercial |
$97.51
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.25
|
| Rate for Payer: MDX Hawaii PPO |
$111.28
|
|
|
LIDOCAINE (PF) 3.5 % OPHT GEL
|
Facility
|
OP
|
$114.72
|
|
|
Service Code
|
NDC 82584079201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.36 |
| Max. Negotiated Rate |
$113.57 |
| Rate for Payer: AlohaCare Medicaid |
$57.36
|
| Rate for Payer: AlohaCare Medicare |
$103.25
|
| Rate for Payer: Cash Price |
$74.57
|
| Rate for Payer: Devoted Health Medicare |
$113.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.25
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$108.98
|
| Rate for Payer: Health Management Network Commercial |
$97.51
|
| Rate for Payer: Humana Medicare |
$103.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.25
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.51
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.25
|
| Rate for Payer: MDX Hawaii PPO |
$111.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.25
|
| Rate for Payer: University Health Alliance Commercial |
$83.62
|
|
|
LIDOCAINE-RACEPINEP-TETRACAINE 4-0.05-0.5 % TOP SOLN
|
Facility
|
OP
|
$86.19
|
|
|
Service Code
|
NDC 70092165844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.09 |
| Max. Negotiated Rate |
$85.33 |
| Rate for Payer: AlohaCare Medicaid |
$43.09
|
| Rate for Payer: AlohaCare Medicare |
$77.57
|
| Rate for Payer: Cash Price |
$56.02
|
| Rate for Payer: Devoted Health Medicare |
$85.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$77.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$81.88
|
| Rate for Payer: Health Management Network Commercial |
$73.26
|
| Rate for Payer: Humana Medicare |
$77.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$43.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$77.57
|
| Rate for Payer: MDX Hawaii PPO |
$83.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$77.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$77.57
|
| Rate for Payer: UnitedHealthcare Medicaid |
$51.71
|
| Rate for Payer: UnitedHealthcare Medicare |
$77.57
|
| Rate for Payer: University Health Alliance Commercial |
$62.82
|
|
|
LIDOCAINE-RACEPINEP-TETRACAINE 4-0.05-0.5 % TOP SOLN
|
Facility
|
IP
|
$86.19
|
|
|
Service Code
|
NDC 70092165844
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.26 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Cash Price |
$56.02
|
| Rate for Payer: Health Management Network Commercial |
$73.26
|
| Rate for Payer: Kaiser Permanente Commercial |
$77.57
|
| Rate for Payer: MDX Hawaii PPO |
$83.60
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOP KIT
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: AlohaCare Medicaid |
$50.40
|
| Rate for Payer: AlohaCare Medicare |
$90.72
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Devoted Health Medicare |
$99.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.72
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.76
|
| Rate for Payer: Health Management Network Commercial |
$85.68
|
| Rate for Payer: Humana Medicare |
$90.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.72
|
| Rate for Payer: MDX Hawaii PPO |
$97.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.72
|
| Rate for Payer: University Health Alliance Commercial |
$73.47
|
|
|
LIDOCAINE-TRANSPARENT DRESSING 4 % TOP KIT
|
Facility
|
IP
|
$100.80
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$97.78 |
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Health Management Network Commercial |
$85.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: MDX Hawaii PPO |
$97.78
|
|
|
LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA
|
Facility
|
IP
|
$214,242.38
|
|
|
Service Code
|
MSDRG 956
|
| Min. Negotiated Rate |
$214,242.38 |
| Max. Negotiated Rate |
$214,242.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$214,242.38
|
|
|
LINEZOLID 600 MG PO TABLET
|
Facility
|
OP
|
$502.27
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$251.13 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: AlohaCare Medicaid |
$251.13
|
| Rate for Payer: AlohaCare Medicaid |
$310.64
|
| Rate for Payer: AlohaCare Medicare |
$559.16
|
| Rate for Payer: AlohaCare Medicare |
$452.04
|
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cash Price |
$403.84
|
| Rate for Payer: Devoted Health Medicare |
$615.08
|
| Rate for Payer: Devoted Health Medicare |
$497.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$559.16
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$452.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$590.23
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$477.16
|
| Rate for Payer: Health Management Network Commercial |
$426.93
|
| Rate for Payer: Health Management Network Commercial |
$528.10
|
| Rate for Payer: Humana Medicare |
$559.16
|
| Rate for Payer: Humana Medicare |
$452.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.04
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$316.86
|
| Rate for Payer: Kaiser Permanente Medicaid |
$256.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$452.04
|
| Rate for Payer: Kaiser Permanente Medicare |
$559.16
|
| Rate for Payer: MDX Hawaii PPO |
$487.20
|
| Rate for Payer: MDX Hawaii PPO |
$602.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$452.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$559.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$452.04
|
| Rate for Payer: Ohana Health Plan Medicare |
$559.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$452.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$559.16
|
| Rate for Payer: University Health Alliance Commercial |
$366.10
|
| Rate for Payer: University Health Alliance Commercial |
$452.86
|
|
|
LINEZOLID 600 MG PO TABLET
|
Facility
|
IP
|
$502.27
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$426.93 |
| Max. Negotiated Rate |
$487.20 |
| Rate for Payer: Cash Price |
$326.48
|
| Rate for Payer: Cash Price |
$403.84
|
| Rate for Payer: Health Management Network Commercial |
$528.10
|
| Rate for Payer: Health Management Network Commercial |
$426.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$559.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$452.04
|
| Rate for Payer: MDX Hawaii PPO |
$487.20
|
| Rate for Payer: MDX Hawaii PPO |
$602.65
|
|
|
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV IVPB
|
Facility
|
IP
|
$96.25
|
|
|
Service Code
|
HCPCS J2020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$93.36 |
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cash Price |
$56.91
|
| Rate for Payer: Cash Price |
$134.41
|
| Rate for Payer: Health Management Network Commercial |
$175.77
|
| Rate for Payer: Health Management Network Commercial |
$81.81
|
| Rate for Payer: Health Management Network Commercial |
$74.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.11
|
| Rate for Payer: MDX Hawaii PPO |
$84.93
|
| Rate for Payer: MDX Hawaii PPO |
$200.59
|
| Rate for Payer: MDX Hawaii PPO |
$93.36
|
|
|
LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV IVPB
|
Facility
|
OP
|
$206.79
|
|
|
Service Code
|
HCPCS J2020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.47 |
| Max. Negotiated Rate |
$204.72 |
| Rate for Payer: AlohaCare Medicaid |
$103.39
|
| Rate for Payer: AlohaCare Medicaid |
$48.12
|
| Rate for Payer: AlohaCare Medicaid |
$43.78
|
| Rate for Payer: AlohaCare Medicare |
$78.80
|
| Rate for Payer: AlohaCare Medicare |
$186.11
|
| Rate for Payer: AlohaCare Medicare |
$86.62
|
| Rate for Payer: Cash Price |
$56.91
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Cash Price |
$56.91
|
| Rate for Payer: Cash Price |
$134.41
|
| Rate for Payer: Cash Price |
$134.41
|
| Rate for Payer: Cash Price |
$62.56
|
| Rate for Payer: Devoted Health Medicare |
$204.72
|
| Rate for Payer: Devoted Health Medicare |
$95.29
|
| Rate for Payer: Devoted Health Medicare |
$86.68
|
| 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 |
$186.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$86.62
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.80
|
| 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 |
$83.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$196.45
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$91.44
|
| Rate for Payer: Health Management Network Commercial |
$81.81
|
| Rate for Payer: Health Management Network Commercial |
$175.77
|
| Rate for Payer: Health Management Network Commercial |
$74.43
|
| Rate for Payer: Humana Medicare |
$186.11
|
| Rate for Payer: Humana Medicare |
$78.80
|
| Rate for Payer: Humana Medicare |
$86.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$186.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$86.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$49.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$105.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$186.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$86.62
|
| Rate for Payer: MDX Hawaii PPO |
$93.36
|
| Rate for Payer: MDX Hawaii PPO |
$84.93
|
| Rate for Payer: MDX Hawaii PPO |
$200.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.80
|
| Rate for Payer: Ohana Health Plan Medicaid |
$186.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$86.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.80
|
| Rate for Payer: Ohana Health Plan Medicare |
$186.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$86.62
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$124.07
|
| Rate for Payer: UnitedHealthcare Medicaid |
$57.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.80
|
| Rate for Payer: UnitedHealthcare Medicare |
$186.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$86.62
|
| Rate for Payer: University Health Alliance Commercial |
$150.73
|
| Rate for Payer: University Health Alliance Commercial |
$63.82
|
| Rate for Payer: University Health Alliance Commercial |
$70.16
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 24,000-76,000 -120,000 UNIT PO CAP DR EC
|
Facility
|
OP
|
$50.73
|
|
|
Service Code
|
NDC 00032263601
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$50.22 |
| Rate for Payer: AlohaCare Medicaid |
$25.36
|
| Rate for Payer: AlohaCare Medicare |
$45.66
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Devoted Health Medicare |
$50.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.19
|
| Rate for Payer: Health Management Network Commercial |
$43.12
|
| Rate for Payer: Humana Medicare |
$45.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.66
|
| Rate for Payer: MDX Hawaii PPO |
$49.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.66
|
| Rate for Payer: University Health Alliance Commercial |
$36.98
|
|
|
LIPASE-PROTEASE-AMYLASE (PORK) 24,000-76,000 -120,000 UNIT PO CAP DR EC
|
Facility
|
IP
|
$50.73
|
|
|
Service Code
|
NDC 00032263601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$49.21 |
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Health Management Network Commercial |
$43.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.66
|
| Rate for Payer: MDX Hawaii PPO |
$49.21
|
|
