|
PHENOBARBITAL SODIUM 130 MG/ML INJ SOLN
|
Facility
|
OP
|
$208.44
|
|
|
Service Code
|
HCPCS J2560
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.36 |
| Max. Negotiated Rate |
$206.36 |
| Rate for Payer: AlohaCare Medicaid |
$104.22
|
| Rate for Payer: AlohaCare Medicare |
$187.60
|
| Rate for Payer: Cash Price |
$135.49
|
| Rate for Payer: Cash Price |
$135.49
|
| Rate for Payer: Devoted Health Medicare |
$206.36
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$27.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$187.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$27.36
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$198.02
|
| Rate for Payer: Health Management Network Commercial |
$177.17
|
| Rate for Payer: Humana Medicare |
$187.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$187.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$106.30
|
| Rate for Payer: Kaiser Permanente Medicare |
$187.60
|
| Rate for Payer: MDX Hawaii PPO |
$202.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$187.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$187.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$125.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$187.60
|
| Rate for Payer: University Health Alliance Commercial |
$151.93
|
|
|
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN
|
Facility
|
IP
|
$15.18
|
|
|
Service Code
|
HCPCS J2371
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Health Management Network Commercial |
$12.90
|
| Rate for Payer: Health Management Network Commercial |
$20.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.33
|
| Rate for Payer: MDX Hawaii PPO |
$22.99
|
| Rate for Payer: MDX Hawaii PPO |
$14.72
|
|
|
PHENYLEPHRINE HCL 10 MG/ML INJ SOLN
|
Facility
|
OP
|
$15.18
|
|
|
Service Code
|
HCPCS J2371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$15.03 |
| Rate for Payer: AlohaCare Medicaid |
$7.59
|
| Rate for Payer: AlohaCare Medicaid |
$11.85
|
| Rate for Payer: AlohaCare Medicare |
$21.33
|
| Rate for Payer: AlohaCare Medicare |
$13.66
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$9.87
|
| Rate for Payer: Cash Price |
$15.40
|
| Rate for Payer: Devoted Health Medicare |
$15.03
|
| Rate for Payer: Devoted Health Medicare |
$23.46
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.33
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.66
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.52
|
| Rate for Payer: Health Management Network Commercial |
$20.14
|
| Rate for Payer: Health Management Network Commercial |
$12.90
|
| Rate for Payer: Humana Medicare |
$13.66
|
| Rate for Payer: Humana Medicare |
$21.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.74
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.33
|
| Rate for Payer: MDX Hawaii PPO |
$14.72
|
| Rate for Payer: MDX Hawaii PPO |
$22.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.33
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.22
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.33
|
| Rate for Payer: University Health Alliance Commercial |
$11.06
|
| Rate for Payer: University Health Alliance Commercial |
$17.27
|
|
|
PHENYLEPHRINE HCL IN 0.9% NACL 40 MG/250 ML (160 MCG/ML) IV SOLN
|
Facility
|
OP
|
$132.89
|
|
|
Service Code
|
HCPCS J2371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$131.56 |
| Rate for Payer: AlohaCare Medicaid |
$66.44
|
| Rate for Payer: AlohaCare Medicare |
$119.60
|
| Rate for Payer: Cash Price |
$86.38
|
| Rate for Payer: Cash Price |
$86.38
|
| Rate for Payer: Devoted Health Medicare |
$131.56
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$119.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.01
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$126.25
|
| Rate for Payer: Health Management Network Commercial |
$112.96
|
| Rate for Payer: Humana Medicare |
$119.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.77
|
| Rate for Payer: Kaiser Permanente Medicare |
$119.60
|
| Rate for Payer: MDX Hawaii PPO |
$128.90
|
| Rate for Payer: Ohana Health Plan Medicaid |
$119.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$119.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.73
|
| Rate for Payer: UnitedHealthcare Medicare |
$119.60
|
| Rate for Payer: University Health Alliance Commercial |
$96.86
|
|
|
PHENYLEPHRINE HCL IN 0.9% NACL 40 MG/250 ML (160 MCG/ML) IV SOLN
|
Facility
|
IP
|
$132.89
|
|
|
Service Code
|
HCPCS J2371
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$128.90 |
| Rate for Payer: Cash Price |
$86.38
|
| Rate for Payer: Health Management Network Commercial |
$112.96
|
| Rate for Payer: Kaiser Permanente Commercial |
$119.60
|
| Rate for Payer: MDX Hawaii PPO |
$128.90
|
|
|
PHENYTOIN 100 MG/4 ML PO SUSP
|
Facility
|
IP
|
$48.49
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.22 |
| Max. Negotiated Rate |
$47.04 |
| Rate for Payer: Cash Price |
$31.52
|
| Rate for Payer: Health Management Network Commercial |
$41.22
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.64
|
| Rate for Payer: MDX Hawaii PPO |
$47.04
|
|
|
PHENYTOIN 100 MG/4 ML PO SUSP
|
Facility
|
OP
|
$48.49
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$24.25 |
| Max. Negotiated Rate |
$48.01 |
| Rate for Payer: AlohaCare Medicaid |
$24.25
|
| Rate for Payer: AlohaCare Medicare |
$43.64
|
| Rate for Payer: Cash Price |
$31.52
|
| Rate for Payer: Devoted Health Medicare |
$48.01
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$43.64
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.07
|
| Rate for Payer: Health Management Network Commercial |
$41.22
|
| Rate for Payer: Humana Medicare |
$43.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$43.64
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.73
|
| Rate for Payer: Kaiser Permanente Medicare |
$43.64
|
| Rate for Payer: MDX Hawaii PPO |
$47.04
|
| Rate for Payer: Ohana Health Plan Medicaid |
$43.64
|
| Rate for Payer: Ohana Health Plan Medicare |
$43.64
|
| Rate for Payer: UnitedHealthcare Medicare |
$43.64
|
| Rate for Payer: University Health Alliance Commercial |
$35.34
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG PO CAP
|
Facility
|
IP
|
$3.54
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3.43 |
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Health Management Network Commercial |
$3.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.19
|
| Rate for Payer: MDX Hawaii PPO |
$3.43
|
|
|
PHENYTOIN SODIUM EXTENDED 100 MG PO CAP
|
Facility
|
OP
|
$3.54
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.77 |
| Max. Negotiated Rate |
$3.50 |
| Rate for Payer: AlohaCare Medicaid |
$1.77
|
| Rate for Payer: AlohaCare Medicare |
$3.19
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Devoted Health Medicare |
$3.50
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.19
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.36
|
| Rate for Payer: Health Management Network Commercial |
$3.01
|
| Rate for Payer: Humana Medicare |
$3.19
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.19
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.81
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.19
|
| Rate for Payer: MDX Hawaii PPO |
$3.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.19
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.19
|
| Rate for Payer: University Health Alliance Commercial |
$2.58
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
OP
|
$220.73
|
|
|
Service Code
|
NDC 00409915850
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$218.52 |
| Rate for Payer: AlohaCare Medicaid |
$110.36
|
| Rate for Payer: AlohaCare Medicare |
$198.66
|
| Rate for Payer: Cash Price |
$143.47
|
| Rate for Payer: Devoted Health Medicare |
$218.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.69
|
| Rate for Payer: Health Management Network Commercial |
$187.62
|
| Rate for Payer: Humana Medicare |
$198.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.66
|
| Rate for Payer: MDX Hawaii PPO |
$214.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.66
|
| Rate for Payer: University Health Alliance Commercial |
$160.89
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
IP
|
$195.07
|
|
|
Service Code
|
NDC 69097070831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Health Management Network Commercial |
$165.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.56
|
| Rate for Payer: MDX Hawaii PPO |
$189.22
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
IP
|
$220.73
|
|
|
Service Code
|
NDC 00409915850
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.62 |
| Max. Negotiated Rate |
$214.11 |
| Rate for Payer: Cash Price |
$143.47
|
| Rate for Payer: Health Management Network Commercial |
$187.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.66
|
| Rate for Payer: MDX Hawaii PPO |
$214.11
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
IP
|
$220.73
|
|
|
Service Code
|
NDC 00409915831
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$187.62 |
| Max. Negotiated Rate |
$214.11 |
| Rate for Payer: Cash Price |
$143.47
|
| Rate for Payer: Health Management Network Commercial |
$187.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.66
|
| Rate for Payer: MDX Hawaii PPO |
$214.11
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
OP
|
$195.07
|
|
|
Service Code
|
NDC 69097070896
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.53 |
| Max. Negotiated Rate |
$193.12 |
| Rate for Payer: AlohaCare Medicaid |
$97.53
|
| Rate for Payer: AlohaCare Medicare |
$175.56
|
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Devoted Health Medicare |
$193.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.32
|
| Rate for Payer: Health Management Network Commercial |
$165.81
|
| Rate for Payer: Humana Medicare |
$175.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.56
|
| Rate for Payer: MDX Hawaii PPO |
$189.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.56
|
| Rate for Payer: University Health Alliance Commercial |
$142.19
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
OP
|
$195.07
|
|
|
Service Code
|
NDC 69097070831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$97.53 |
| Max. Negotiated Rate |
$193.12 |
| Rate for Payer: AlohaCare Medicaid |
$97.53
|
| Rate for Payer: AlohaCare Medicare |
$175.56
|
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Devoted Health Medicare |
$193.12
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.32
|
| Rate for Payer: Health Management Network Commercial |
$165.81
|
| Rate for Payer: Humana Medicare |
$175.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.56
|
| Rate for Payer: MDX Hawaii PPO |
$189.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.56
|
| Rate for Payer: University Health Alliance Commercial |
$142.19
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
IP
|
$195.07
|
|
|
Service Code
|
NDC 69097070896
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Health Management Network Commercial |
$165.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.56
|
| Rate for Payer: MDX Hawaii PPO |
$189.22
|
|
|
PHYTONADIONE 10 MG/ML INJ ORAL SOLN
|
Facility
|
OP
|
$220.73
|
|
|
Service Code
|
NDC 00409915831
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$110.36 |
| Max. Negotiated Rate |
$218.52 |
| Rate for Payer: AlohaCare Medicaid |
$110.36
|
| Rate for Payer: AlohaCare Medicare |
$198.66
|
| Rate for Payer: Cash Price |
$143.47
|
| Rate for Payer: Devoted Health Medicare |
$218.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$198.66
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$209.69
|
| Rate for Payer: Health Management Network Commercial |
$187.62
|
| Rate for Payer: Humana Medicare |
$198.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$198.66
|
| Rate for Payer: Kaiser Permanente Medicaid |
$112.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$198.66
|
| Rate for Payer: MDX Hawaii PPO |
$214.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$198.66
|
| Rate for Payer: Ohana Health Plan Medicare |
$198.66
|
| Rate for Payer: UnitedHealthcare Medicare |
$198.66
|
| Rate for Payer: University Health Alliance Commercial |
$160.89
|
|
|
PHYTONADIONE 10 MG/ML INJ SOLN (SQ)
|
Facility
|
OP
|
$195.07
|
|
|
Service Code
|
HCPCS J3430
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.84 |
| Max. Negotiated Rate |
$193.12 |
| Rate for Payer: AlohaCare Medicaid |
$97.53
|
| Rate for Payer: AlohaCare Medicare |
$175.56
|
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Devoted Health Medicare |
$193.12
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.84
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$175.56
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.84
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$185.32
|
| Rate for Payer: Health Management Network Commercial |
$165.81
|
| Rate for Payer: Humana Medicare |
$175.56
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.56
|
| Rate for Payer: Kaiser Permanente Medicaid |
$99.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$175.56
|
| Rate for Payer: MDX Hawaii PPO |
$189.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$175.56
|
| Rate for Payer: Ohana Health Plan Medicare |
$175.56
|
| Rate for Payer: UnitedHealthcare Medicaid |
$117.04
|
| Rate for Payer: UnitedHealthcare Medicare |
$175.56
|
| Rate for Payer: University Health Alliance Commercial |
$142.19
|
|
|
PHYTONADIONE 10 MG/ML INJ SOLN (SQ)
|
Facility
|
IP
|
$195.07
|
|
|
Service Code
|
HCPCS J3430
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$165.81 |
| Max. Negotiated Rate |
$189.22 |
| Rate for Payer: Cash Price |
$126.80
|
| Rate for Payer: Health Management Network Commercial |
$165.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$175.56
|
| Rate for Payer: MDX Hawaii PPO |
$189.22
|
|
|
PICC DOUBLE LUMEN 4FR [2702979]
|
Facility
|
IP
|
$1,835.13
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2702979.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,559.86 |
| Max. Negotiated Rate |
$1,780.08 |
| Rate for Payer: Cash Price |
$1,192.83
|
| Rate for Payer: Health Management Network Commercial |
$1,559.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,651.62
|
| Rate for Payer: MDX Hawaii PPO |
$1,780.08
|
|
|
PICC DOUBLE LUMEN 4FR [2702979]
|
Facility
|
OP
|
$1,835.13
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
2702979.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$917.57 |
| Max. Negotiated Rate |
$1,816.78 |
| Rate for Payer: AlohaCare Medicaid |
$917.57
|
| Rate for Payer: AlohaCare Medicare |
$1,651.62
|
| Rate for Payer: Cash Price |
$1,192.83
|
| Rate for Payer: Devoted Health Medicare |
$1,816.78
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,651.62
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,743.37
|
| Rate for Payer: Health Management Network Commercial |
$1,559.86
|
| Rate for Payer: Humana Medicare |
$1,651.62
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,651.62
|
| Rate for Payer: Kaiser Permanente Medicaid |
$935.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,651.62
|
| Rate for Payer: MDX Hawaii PPO |
$1,780.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,651.62
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,651.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,651.62
|
| Rate for Payer: University Health Alliance Commercial |
$1,337.63
|
|
|
PICC NEEDLE GUIDE KIT [2702964]
|
Facility
|
IP
|
$136.00
|
|
| Hospital Charge Code |
2702964.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.60 |
| Max. Negotiated Rate |
$131.92 |
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.40
|
| Rate for Payer: MDX Hawaii PPO |
$131.92
|
|
|
PICC NEEDLE GUIDE KIT [2702964]
|
Facility
|
OP
|
$136.00
|
|
| Hospital Charge Code |
2702964.0
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$134.64 |
| Rate for Payer: AlohaCare Medicaid |
$68.00
|
| Rate for Payer: AlohaCare Medicare |
$122.40
|
| Rate for Payer: Cash Price |
$88.40
|
| Rate for Payer: Devoted Health Medicare |
$134.64
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$122.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$129.20
|
| Rate for Payer: Health Management Network Commercial |
$115.60
|
| Rate for Payer: Humana Medicare |
$122.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$69.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$122.40
|
| Rate for Payer: MDX Hawaii PPO |
$131.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$122.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$122.40
|
| Rate for Payer: UnitedHealthcare Medicare |
$122.40
|
| Rate for Payer: University Health Alliance Commercial |
$99.13
|
|
|
PILOCARPINE HCL 1 % OPHT DROP
|
Facility
|
IP
|
$420.08
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$357.07 |
| Max. Negotiated Rate |
$407.48 |
| Rate for Payer: Cash Price |
$273.05
|
| Rate for Payer: Health Management Network Commercial |
$357.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$378.07
|
| Rate for Payer: MDX Hawaii PPO |
$407.48
|
|
|
PILOCARPINE HCL 1 % OPHT DROP
|
Facility
|
OP
|
$420.08
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.04 |
| Max. Negotiated Rate |
$415.88 |
| Rate for Payer: AlohaCare Medicaid |
$210.04
|
| Rate for Payer: AlohaCare Medicare |
$378.07
|
| Rate for Payer: Cash Price |
$273.05
|
| Rate for Payer: Devoted Health Medicare |
$415.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$378.07
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$399.08
|
| Rate for Payer: Health Management Network Commercial |
$357.07
|
| Rate for Payer: Humana Medicare |
$378.07
|
| Rate for Payer: Kaiser Permanente Commercial |
$378.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$214.24
|
| Rate for Payer: Kaiser Permanente Medicare |
$378.07
|
| Rate for Payer: MDX Hawaii PPO |
$407.48
|
| Rate for Payer: Ohana Health Plan Medicaid |
$378.07
|
| Rate for Payer: Ohana Health Plan Medicare |
$378.07
|
| Rate for Payer: UnitedHealthcare Medicare |
$378.07
|
| Rate for Payer: University Health Alliance Commercial |
$306.20
|
|
