|
PIOGLITAZONE 15 MG PO TABLET
|
Facility
|
IP
|
$43.49
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.97 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Health Management Network Commercial |
$36.97
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.14
|
| Rate for Payer: MDX Hawaii PPO |
$42.19
|
|
|
PIOGLITAZONE 15 MG PO TABLET
|
Facility
|
OP
|
$43.49
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: AlohaCare Medicaid |
$21.75
|
| Rate for Payer: AlohaCare Medicare |
$39.14
|
| Rate for Payer: Cash Price |
$28.27
|
| Rate for Payer: Devoted Health Medicare |
$43.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.14
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$41.32
|
| Rate for Payer: Health Management Network Commercial |
$36.97
|
| Rate for Payer: Humana Medicare |
$39.14
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.14
|
| Rate for Payer: MDX Hawaii PPO |
$42.19
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.14
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.14
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.14
|
| Rate for Payer: University Health Alliance Commercial |
$31.70
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV RECON.SOLN.
|
Facility
|
OP
|
$68.96
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$68.27 |
| Rate for Payer: AlohaCare Medicaid |
$34.48
|
| Rate for Payer: AlohaCare Medicaid |
$9.94
|
| Rate for Payer: AlohaCare Medicare |
$17.89
|
| Rate for Payer: AlohaCare Medicare |
$62.06
|
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Devoted Health Medicare |
$19.68
|
| Rate for Payer: Devoted Health Medicare |
$68.27
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.89
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.89
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.51
|
| Rate for Payer: Health Management Network Commercial |
$58.62
|
| Rate for Payer: Health Management Network Commercial |
$16.90
|
| Rate for Payer: Humana Medicare |
$62.06
|
| Rate for Payer: Humana Medicare |
$17.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.06
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.17
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.89
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.06
|
| Rate for Payer: MDX Hawaii PPO |
$66.89
|
| Rate for Payer: MDX Hawaii PPO |
$19.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.89
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$11.93
|
| Rate for Payer: UnitedHealthcare Medicaid |
$41.38
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.89
|
| Rate for Payer: University Health Alliance Commercial |
$50.26
|
| Rate for Payer: University Health Alliance Commercial |
$14.49
|
|
|
PIPERACILLIN-TAZOBACTAM 2.25 GRAM IV RECON.SOLN.
|
Facility
|
IP
|
$68.96
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.62 |
| Max. Negotiated Rate |
$66.89 |
| Rate for Payer: Cash Price |
$44.82
|
| Rate for Payer: Cash Price |
$12.92
|
| Rate for Payer: Health Management Network Commercial |
$58.62
|
| Rate for Payer: Health Management Network Commercial |
$16.90
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.89
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.06
|
| Rate for Payer: MDX Hawaii PPO |
$19.28
|
| Rate for Payer: MDX Hawaii PPO |
$66.89
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV RECON.SOLN.
|
Facility
|
IP
|
$94.45
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$80.28 |
| Max. Negotiated Rate |
$91.62 |
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Health Management Network Commercial |
$80.28
|
| Rate for Payer: Health Management Network Commercial |
$75.74
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.37
|
| Rate for Payer: MDX Hawaii PPO |
$86.44
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: MDX Hawaii PPO |
$91.62
|
|
|
PIPERACILLIN-TAZOBACTAM 3.375 GRAM IV RECON.SOLN.
|
Facility
|
OP
|
$41.52
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$41.10 |
| Rate for Payer: AlohaCare Medicaid |
$20.76
|
| Rate for Payer: AlohaCare Medicaid |
$47.23
|
| Rate for Payer: AlohaCare Medicaid |
$44.55
|
| Rate for Payer: AlohaCare Medicare |
$80.20
|
| Rate for Payer: AlohaCare Medicare |
$37.37
|
| Rate for Payer: AlohaCare Medicare |
$85.00
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Cash Price |
$57.92
|
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Cash Price |
$61.39
|
| Rate for Payer: Devoted Health Medicare |
$41.10
|
| Rate for Payer: Devoted Health Medicare |
$93.51
|
| Rate for Payer: Devoted Health Medicare |
$88.22
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$85.00
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$80.20
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$84.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$89.73
|
| Rate for Payer: Health Management Network Commercial |
$80.28
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Health Management Network Commercial |
$75.74
|
| Rate for Payer: Humana Medicare |
$37.37
|
| Rate for Payer: Humana Medicare |
$80.20
|
| Rate for Payer: Humana Medicare |
$85.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$80.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$85.00
|
| Rate for Payer: Kaiser Permanente Medicaid |
$48.17
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.45
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$80.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$85.00
|
| Rate for Payer: MDX Hawaii PPO |
$91.62
|
| Rate for Payer: MDX Hawaii PPO |
$86.44
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: Ohana Health Plan Medicaid |
$80.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$85.00
|
| Rate for Payer: Ohana Health Plan Medicare |
$80.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$85.00
|
| Rate for Payer: UnitedHealthcare Medicaid |
$53.47
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$56.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$80.20
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$85.00
|
| Rate for Payer: University Health Alliance Commercial |
$30.26
|
| Rate for Payer: University Health Alliance Commercial |
$64.95
|
| Rate for Payer: University Health Alliance Commercial |
$68.84
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV RECON.SOLN.
|
Facility
|
OP
|
$132.06
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.11 |
| Max. Negotiated Rate |
$130.74 |
| Rate for Payer: AlohaCare Medicaid |
$66.03
|
| Rate for Payer: AlohaCare Medicaid |
$23.66
|
| Rate for Payer: AlohaCare Medicaid |
$57.41
|
| Rate for Payer: AlohaCare Medicaid |
$54.02
|
| Rate for Payer: AlohaCare Medicare |
$97.25
|
| Rate for Payer: AlohaCare Medicare |
$103.34
|
| Rate for Payer: AlohaCare Medicare |
$118.85
|
| Rate for Payer: AlohaCare Medicare |
$42.60
|
| Rate for Payer: Cash Price |
$70.23
|
| Rate for Payer: Cash Price |
$85.84
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$85.84
|
| Rate for Payer: Cash Price |
$30.76
|
| Rate for Payer: Cash Price |
$70.23
|
| Rate for Payer: Cash Price |
$30.76
|
| Rate for Payer: Devoted Health Medicare |
$113.67
|
| Rate for Payer: Devoted Health Medicare |
$130.74
|
| Rate for Payer: Devoted Health Medicare |
$106.97
|
| Rate for Payer: Devoted Health Medicare |
$46.86
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$103.34
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.60
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$97.25
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$118.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.11
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$125.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$102.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$109.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.96
|
| Rate for Payer: Health Management Network Commercial |
$40.23
|
| Rate for Payer: Health Management Network Commercial |
$97.60
|
| Rate for Payer: Health Management Network Commercial |
$91.84
|
| Rate for Payer: Health Management Network Commercial |
$112.25
|
| Rate for Payer: Humana Medicare |
$103.34
|
| Rate for Payer: Humana Medicare |
$97.25
|
| Rate for Payer: Humana Medicare |
$118.85
|
| Rate for Payer: Humana Medicare |
$42.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.34
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.60
|
| Rate for Payer: Kaiser Permanente Medicaid |
$55.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$67.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.14
|
| Rate for Payer: Kaiser Permanente Medicaid |
$58.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$103.34
|
| Rate for Payer: Kaiser Permanente Medicare |
$118.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$97.25
|
| Rate for Payer: MDX Hawaii PPO |
$45.91
|
| Rate for Payer: MDX Hawaii PPO |
$128.10
|
| Rate for Payer: MDX Hawaii PPO |
$111.38
|
| Rate for Payer: MDX Hawaii PPO |
$104.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$103.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$97.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$118.85
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$103.34
|
| Rate for Payer: Ohana Health Plan Medicare |
$97.25
|
| Rate for Payer: Ohana Health Plan Medicare |
$118.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.60
|
| Rate for Payer: UnitedHealthcare Medicaid |
$68.89
|
| Rate for Payer: UnitedHealthcare Medicaid |
$79.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$28.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$64.83
|
| Rate for Payer: UnitedHealthcare Medicare |
$118.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$103.34
|
| Rate for Payer: UnitedHealthcare Medicare |
$97.25
|
| Rate for Payer: University Health Alliance Commercial |
$34.50
|
| Rate for Payer: University Health Alliance Commercial |
$96.26
|
| Rate for Payer: University Health Alliance Commercial |
$78.76
|
| Rate for Payer: University Health Alliance Commercial |
$83.69
|
|
|
PIPERACILLIN-TAZOBACTAM 4.5 GRAM IV RECON.SOLN.
|
Facility
|
IP
|
$114.82
|
|
|
Service Code
|
HCPCS J2543
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.60 |
| Max. Negotiated Rate |
$111.38 |
| Rate for Payer: Cash Price |
$74.63
|
| Rate for Payer: Cash Price |
$70.23
|
| Rate for Payer: Cash Price |
$30.76
|
| Rate for Payer: Cash Price |
$85.84
|
| Rate for Payer: Health Management Network Commercial |
$91.84
|
| Rate for Payer: Health Management Network Commercial |
$97.60
|
| Rate for Payer: Health Management Network Commercial |
$112.25
|
| Rate for Payer: Health Management Network Commercial |
$40.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$97.25
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$118.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$103.34
|
| Rate for Payer: MDX Hawaii PPO |
$104.81
|
| Rate for Payer: MDX Hawaii PPO |
$128.10
|
| Rate for Payer: MDX Hawaii PPO |
$45.91
|
| Rate for Payer: MDX Hawaii PPO |
$111.38
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$27,565.43
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$27,565.43 |
| Max. Negotiated Rate |
$27,565.43 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$27,565.43
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$28,205.38
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$28,205.38 |
| Max. Negotiated Rate |
$28,205.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$28,205.38
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$22,516.90
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$22,516.90 |
| Max. Negotiated Rate |
$22,516.90 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$22,516.90
|
|
|
PNEUMOC 15-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR
|
Facility
|
OP
|
$737.98
|
|
|
Service Code
|
HCPCS 90671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$253.56 |
| Max. Negotiated Rate |
$730.60 |
| Rate for Payer: AlohaCare Medicaid |
$368.99
|
| Rate for Payer: AlohaCare Medicare |
$664.18
|
| Rate for Payer: Cash Price |
$479.69
|
| Rate for Payer: Cash Price |
$479.69
|
| Rate for Payer: Devoted Health Medicare |
$730.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$253.56
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$664.18
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$253.56
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$701.08
|
| Rate for Payer: Health Management Network Commercial |
$627.28
|
| Rate for Payer: Humana Medicare |
$664.18
|
| Rate for Payer: Kaiser Permanente Commercial |
$664.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$376.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$664.18
|
| Rate for Payer: MDX Hawaii PPO |
$715.84
|
| Rate for Payer: Ohana Health Plan Medicaid |
$664.18
|
| Rate for Payer: Ohana Health Plan Medicare |
$664.18
|
| Rate for Payer: UnitedHealthcare Medicaid |
$442.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$664.18
|
| Rate for Payer: University Health Alliance Commercial |
$537.91
|
|
|
PNEUMOC 15-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR
|
Facility
|
IP
|
$737.98
|
|
|
Service Code
|
HCPCS 90671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$627.28 |
| Max. Negotiated Rate |
$715.84 |
| Rate for Payer: Cash Price |
$479.69
|
| Rate for Payer: Health Management Network Commercial |
$627.28
|
| Rate for Payer: Kaiser Permanente Commercial |
$664.18
|
| Rate for Payer: MDX Hawaii PPO |
$715.84
|
|
|
PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR
|
Facility
|
IP
|
$765.68
|
|
|
Service Code
|
HCPCS 90677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$650.83 |
| Max. Negotiated Rate |
$742.71 |
| Rate for Payer: Cash Price |
$497.69
|
| Rate for Payer: Cash Price |
$525.54
|
| Rate for Payer: Health Management Network Commercial |
$687.24
|
| Rate for Payer: Health Management Network Commercial |
$650.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$689.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$727.67
|
| Rate for Payer: MDX Hawaii PPO |
$742.71
|
| Rate for Payer: MDX Hawaii PPO |
$784.26
|
|
|
PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYR
|
Facility
|
OP
|
$808.52
|
|
|
Service Code
|
HCPCS 90677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$298.04 |
| Max. Negotiated Rate |
$800.43 |
| Rate for Payer: AlohaCare Medicaid |
$404.26
|
| Rate for Payer: AlohaCare Medicaid |
$382.84
|
| Rate for Payer: AlohaCare Medicare |
$689.11
|
| Rate for Payer: AlohaCare Medicare |
$727.67
|
| Rate for Payer: Cash Price |
$497.69
|
| Rate for Payer: Cash Price |
$497.69
|
| Rate for Payer: Cash Price |
$525.54
|
| Rate for Payer: Cash Price |
$525.54
|
| Rate for Payer: Devoted Health Medicare |
$758.02
|
| Rate for Payer: Devoted Health Medicare |
$800.43
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$298.04
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$298.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$689.11
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$727.67
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$298.04
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$298.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$727.40
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$768.09
|
| Rate for Payer: Health Management Network Commercial |
$650.83
|
| Rate for Payer: Health Management Network Commercial |
$687.24
|
| Rate for Payer: Humana Medicare |
$689.11
|
| Rate for Payer: Humana Medicare |
$727.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$727.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$689.11
|
| Rate for Payer: Kaiser Permanente Medicaid |
$390.50
|
| Rate for Payer: Kaiser Permanente Medicaid |
$412.35
|
| Rate for Payer: Kaiser Permanente Medicare |
$689.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$727.67
|
| Rate for Payer: MDX Hawaii PPO |
$742.71
|
| Rate for Payer: MDX Hawaii PPO |
$784.26
|
| Rate for Payer: Ohana Health Plan Medicaid |
$727.67
|
| Rate for Payer: Ohana Health Plan Medicaid |
$689.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$689.11
|
| Rate for Payer: Ohana Health Plan Medicare |
$727.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$459.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$485.11
|
| Rate for Payer: UnitedHealthcare Medicare |
$727.67
|
| Rate for Payer: UnitedHealthcare Medicare |
$689.11
|
| Rate for Payer: University Health Alliance Commercial |
$558.10
|
| Rate for Payer: University Health Alliance Commercial |
$589.33
|
|
|
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYR
|
Facility
|
IP
|
$483.07
|
|
|
Service Code
|
HCPCS 90732
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$410.61 |
| Max. Negotiated Rate |
$468.58 |
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Health Management Network Commercial |
$410.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.76
|
| Rate for Payer: MDX Hawaii PPO |
$468.58
|
|
|
PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYR
|
Facility
|
OP
|
$483.07
|
|
|
Service Code
|
HCPCS 90732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.47 |
| Max. Negotiated Rate |
$478.24 |
| Rate for Payer: AlohaCare Medicaid |
$241.53
|
| Rate for Payer: AlohaCare Medicare |
$434.76
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Cash Price |
$314.00
|
| Rate for Payer: Devoted Health Medicare |
$478.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$133.47
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$434.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$133.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$458.92
|
| Rate for Payer: Health Management Network Commercial |
$410.61
|
| Rate for Payer: Humana Medicare |
$434.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$434.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$246.37
|
| Rate for Payer: Kaiser Permanente Medicare |
$434.76
|
| Rate for Payer: MDX Hawaii PPO |
$468.58
|
| Rate for Payer: Ohana Health Plan Medicaid |
$434.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$434.76
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.84
|
| Rate for Payer: UnitedHealthcare Medicare |
$434.76
|
| Rate for Payer: University Health Alliance Commercial |
$352.11
|
|
|
PNEUMOTHORAX WITH CC
|
Facility
|
IP
|
$17,373.57
|
|
|
Service Code
|
MSDRG 200
|
| Min. Negotiated Rate |
$17,373.57 |
| Max. Negotiated Rate |
$17,373.57 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$17,373.57
|
|
|
PNEUMOTHORAX WITH MCC
|
Facility
|
IP
|
$18,321.65
|
|
|
Service Code
|
MSDRG 199
|
| Min. Negotiated Rate |
$18,321.65 |
| Max. Negotiated Rate |
$18,321.65 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$18,321.65
|
|
|
PNEUMOTHORAX WITHOUT CC/MCC
|
Facility
|
IP
|
$13,770.86
|
|
|
Service Code
|
MSDRG 201
|
| Min. Negotiated Rate |
$13,770.86 |
| Max. Negotiated Rate |
$13,770.86 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$13,770.86
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC
|
Facility
|
IP
|
$20,597.04
|
|
|
Service Code
|
MSDRG 917
|
| Min. Negotiated Rate |
$20,597.04 |
| Max. Negotiated Rate |
$20,597.04 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$20,597.04
|
|
|
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC
|
Facility
|
IP
|
$15,714.43
|
|
|
Service Code
|
MSDRG 918
|
| Min. Negotiated Rate |
$15,714.43 |
| Max. Negotiated Rate |
$15,714.43 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$15,714.43
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM PO POWDER PACK
|
Facility
|
IP
|
$10.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cash Price |
$4.63
|
| Rate for Payer: Health Management Network Commercial |
$6.06
|
| Rate for Payer: Health Management Network Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.42
|
| Rate for Payer: MDX Hawaii PPO |
$10.28
|
| Rate for Payer: MDX Hawaii PPO |
$6.92
|
|
|
POLYETHYLENE GLYCOL 3350 17 GRAM PO POWDER PACK
|
Facility
|
OP
|
$10.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$10.49 |
| Rate for Payer: AlohaCare Medicaid |
$5.30
|
| Rate for Payer: AlohaCare Medicaid |
$3.56
|
| Rate for Payer: AlohaCare Medicare |
$9.54
|
| Rate for Payer: AlohaCare Medicare |
$6.42
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Cash Price |
$4.63
|
| Rate for Payer: Devoted Health Medicare |
$10.49
|
| Rate for Payer: Devoted Health Medicare |
$7.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$6.42
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$10.07
|
| Rate for Payer: Health Management Network Commercial |
$9.01
|
| Rate for Payer: Health Management Network Commercial |
$6.06
|
| Rate for Payer: Humana Medicare |
$9.54
|
| Rate for Payer: Humana Medicare |
$6.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$6.42
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.54
|
| Rate for Payer: Kaiser Permanente Medicare |
$6.42
|
| Rate for Payer: MDX Hawaii PPO |
$10.28
|
| Rate for Payer: MDX Hawaii PPO |
$6.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$6.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$6.42
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$6.42
|
| Rate for Payer: University Health Alliance Commercial |
$7.73
|
| Rate for Payer: University Health Alliance Commercial |
$5.20
|
|
|
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC
|
Facility
|
IP
|
$21,545.12
|
|
|
Service Code
|
MSDRG 862
|
| Min. Negotiated Rate |
$21,545.12 |
| Max. Negotiated Rate |
$21,545.12 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21,545.12
|
|
