|
TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYR
|
Facility
|
IP
|
$186.71
|
|
|
Service Code
|
HCPCS 90714
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$158.70 |
| Max. Negotiated Rate |
$181.11 |
| Rate for Payer: Cash Price |
$121.36
|
| Rate for Payer: Cash Price |
$121.35
|
| Rate for Payer: Health Management Network Commercial |
$158.70
|
| Rate for Payer: Health Management Network Commercial |
$158.69
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$168.04
|
| Rate for Payer: MDX Hawaii PPO |
$181.11
|
| Rate for Payer: MDX Hawaii PPO |
$181.09
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT IM SYR
|
Facility
|
IP
|
$1,587.68
|
|
|
Service Code
|
HCPCS J1670
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,349.53 |
| Max. Negotiated Rate |
$1,540.05 |
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Health Management Network Commercial |
$1,349.53
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,428.91
|
| Rate for Payer: MDX Hawaii PPO |
$1,540.05
|
|
|
TETANUS IMMUNE GLOBULIN (PF) 250 UNIT IM SYR
|
Facility
|
OP
|
$1,587.68
|
|
|
Service Code
|
HCPCS J1670
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$577.05 |
| Max. Negotiated Rate |
$1,571.80 |
| Rate for Payer: AlohaCare Medicaid |
$793.84
|
| Rate for Payer: AlohaCare Medicare |
$1,428.91
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Cash Price |
$1,031.99
|
| Rate for Payer: Devoted Health Medicare |
$1,571.80
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$577.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$697.65
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1,428.91
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$577.05
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,508.30
|
| Rate for Payer: Health Management Network Commercial |
$1,349.53
|
| Rate for Payer: Humana Medicare |
$1,428.91
|
| Rate for Payer: Kaiser Permanente Commercial |
$1,428.91
|
| Rate for Payer: Kaiser Permanente Medicaid |
$809.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$1,428.91
|
| Rate for Payer: MDX Hawaii PPO |
$1,540.05
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1,428.91
|
| Rate for Payer: Ohana Health Plan Medicare |
$1,428.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$952.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$1,428.91
|
| Rate for Payer: University Health Alliance Commercial |
$1,157.26
|
|
|
TETRACAINE HCL (PF) 0.5 % OPHT DROP
|
Facility
|
IP
|
$75.47
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.15 |
| Max. Negotiated Rate |
$73.21 |
| Rate for Payer: Cash Price |
$49.06
|
| Rate for Payer: Health Management Network Commercial |
$64.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.92
|
| Rate for Payer: MDX Hawaii PPO |
$73.21
|
|
|
TETRACAINE HCL (PF) 0.5 % OPHT DROP
|
Facility
|
OP
|
$75.47
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$74.72 |
| Rate for Payer: AlohaCare Medicaid |
$37.73
|
| Rate for Payer: AlohaCare Medicare |
$67.92
|
| Rate for Payer: Cash Price |
$49.06
|
| Rate for Payer: Devoted Health Medicare |
$74.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.92
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.70
|
| Rate for Payer: Health Management Network Commercial |
$64.15
|
| Rate for Payer: Humana Medicare |
$67.92
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.92
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.49
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.92
|
| Rate for Payer: MDX Hawaii PPO |
$73.21
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.92
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.92
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.92
|
| Rate for Payer: University Health Alliance Commercial |
$55.01
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN
|
Facility
|
OP
|
$44.42
|
|
|
Service Code
|
HCPCS J3411
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$43.98 |
| Rate for Payer: AlohaCare Medicaid |
$22.21
|
| Rate for Payer: AlohaCare Medicaid |
$30.60
|
| Rate for Payer: AlohaCare Medicaid |
$28.86
|
| Rate for Payer: AlohaCare Medicare |
$51.95
|
| Rate for Payer: AlohaCare Medicare |
$39.98
|
| Rate for Payer: AlohaCare Medicare |
$55.08
|
| Rate for Payer: Cash Price |
$37.52
|
| Rate for Payer: Cash Price |
$39.78
|
| Rate for Payer: Cash Price |
$37.52
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Cash Price |
$39.78
|
| Rate for Payer: Devoted Health Medicare |
$43.98
|
| Rate for Payer: Devoted Health Medicare |
$60.59
|
| Rate for Payer: Devoted Health Medicare |
$57.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.79
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.79
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$39.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$55.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$51.95
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.79
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$54.83
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$42.20
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$58.14
|
| Rate for Payer: Health Management Network Commercial |
$52.02
|
| Rate for Payer: Health Management Network Commercial |
$37.76
|
| Rate for Payer: Health Management Network Commercial |
$49.06
|
| Rate for Payer: Humana Medicare |
$39.98
|
| Rate for Payer: Humana Medicare |
$51.95
|
| Rate for Payer: Humana Medicare |
$55.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$31.21
|
| Rate for Payer: Kaiser Permanente Medicaid |
$29.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$22.65
|
| Rate for Payer: Kaiser Permanente Medicare |
$39.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$51.95
|
| Rate for Payer: Kaiser Permanente Medicare |
$55.08
|
| Rate for Payer: MDX Hawaii PPO |
$59.36
|
| Rate for Payer: MDX Hawaii PPO |
$55.99
|
| Rate for Payer: MDX Hawaii PPO |
$43.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$51.95
|
| Rate for Payer: Ohana Health Plan Medicaid |
$39.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$55.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$51.95
|
| Rate for Payer: Ohana Health Plan Medicare |
$39.98
|
| Rate for Payer: Ohana Health Plan Medicare |
$55.08
|
| Rate for Payer: UnitedHealthcare Medicaid |
$34.63
|
| Rate for Payer: UnitedHealthcare Medicaid |
$26.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$36.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$51.95
|
| Rate for Payer: UnitedHealthcare Medicare |
$39.98
|
| Rate for Payer: UnitedHealthcare Medicare |
$55.08
|
| Rate for Payer: University Health Alliance Commercial |
$32.38
|
| Rate for Payer: University Health Alliance Commercial |
$42.07
|
| Rate for Payer: University Health Alliance Commercial |
$44.61
|
|
|
THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN
|
Facility
|
IP
|
$61.20
|
|
|
Service Code
|
HCPCS J3411
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.02 |
| Max. Negotiated Rate |
$59.36 |
| Rate for Payer: Cash Price |
$39.78
|
| Rate for Payer: Cash Price |
$37.52
|
| Rate for Payer: Cash Price |
$28.87
|
| Rate for Payer: Health Management Network Commercial |
$37.76
|
| Rate for Payer: Health Management Network Commercial |
$52.02
|
| Rate for Payer: Health Management Network Commercial |
$49.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$51.95
|
| Rate for Payer: Kaiser Permanente Commercial |
$55.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$39.98
|
| Rate for Payer: MDX Hawaii PPO |
$55.99
|
| Rate for Payer: MDX Hawaii PPO |
$43.09
|
| Rate for Payer: MDX Hawaii PPO |
$59.36
|
|
|
THIAMINE MONONITRATE (VIT B1) 100 MG PO TABLET
|
Facility
|
OP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.19 |
| Rate for Payer: AlohaCare Medicaid |
$0.60
|
| Rate for Payer: AlohaCare Medicaid |
$0.87
|
| Rate for Payer: AlohaCare Medicare |
$1.08
|
| Rate for Payer: AlohaCare Medicare |
$1.57
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Devoted Health Medicare |
$1.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Health Management Network Commercial |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.57
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.89
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.69
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.57
|
| Rate for Payer: University Health Alliance Commercial |
$1.27
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
THIAMINE MONONITRATE (VIT B1) 100 MG PO TABLET
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.48 |
| Max. Negotiated Rate |
$1.69 |
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.48
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: MDX Hawaii PPO |
$1.69
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$21,047.38
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$21,047.38 |
| Max. Negotiated Rate |
$21,047.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21,047.38
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$21,047.38
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$21,047.38 |
| Max. Negotiated Rate |
$21,047.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21,047.38
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$21,047.38
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$21,047.38 |
| Max. Negotiated Rate |
$21,047.38 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$21,047.38
|
|
|
THYROID (PORK) 60 MG PO TABLET
|
Facility
|
OP
|
$6.41
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$6.35 |
| Rate for Payer: AlohaCare Medicaid |
$3.21
|
| Rate for Payer: AlohaCare Medicare |
$5.77
|
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Devoted Health Medicare |
$6.35
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$5.77
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$6.09
|
| Rate for Payer: Health Management Network Commercial |
$5.45
|
| Rate for Payer: Humana Medicare |
$5.77
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.77
|
| Rate for Payer: Kaiser Permanente Medicaid |
$3.27
|
| Rate for Payer: Kaiser Permanente Medicare |
$5.77
|
| Rate for Payer: MDX Hawaii PPO |
$6.22
|
| Rate for Payer: Ohana Health Plan Medicaid |
$5.77
|
| Rate for Payer: Ohana Health Plan Medicare |
$5.77
|
| Rate for Payer: UnitedHealthcare Medicare |
$5.77
|
| Rate for Payer: University Health Alliance Commercial |
$4.67
|
|
|
THYROID (PORK) 60 MG PO TABLET
|
Facility
|
IP
|
$6.41
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.45 |
| Max. Negotiated Rate |
$6.22 |
| Rate for Payer: Cash Price |
$4.17
|
| Rate for Payer: Health Management Network Commercial |
$5.45
|
| Rate for Payer: Kaiser Permanente Commercial |
$5.77
|
| Rate for Payer: MDX Hawaii PPO |
$6.22
|
|
|
TICAGRELOR 90 MG PO TABLET
|
Facility
|
IP
|
$47.06
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$45.65 |
| Rate for Payer: Cash Price |
$30.59
|
| Rate for Payer: Health Management Network Commercial |
$40.00
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.35
|
| Rate for Payer: MDX Hawaii PPO |
$45.65
|
|
|
TICAGRELOR 90 MG PO TABLET
|
Facility
|
OP
|
$47.06
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.53 |
| Max. Negotiated Rate |
$46.59 |
| Rate for Payer: AlohaCare Medicaid |
$23.53
|
| Rate for Payer: AlohaCare Medicare |
$42.35
|
| Rate for Payer: Cash Price |
$30.59
|
| Rate for Payer: Devoted Health Medicare |
$46.59
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$42.35
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$44.71
|
| Rate for Payer: Health Management Network Commercial |
$40.00
|
| Rate for Payer: Humana Medicare |
$42.35
|
| Rate for Payer: Kaiser Permanente Commercial |
$42.35
|
| Rate for Payer: Kaiser Permanente Medicaid |
$24.00
|
| Rate for Payer: Kaiser Permanente Medicare |
$42.35
|
| Rate for Payer: MDX Hawaii PPO |
$45.65
|
| Rate for Payer: Ohana Health Plan Medicaid |
$42.35
|
| Rate for Payer: Ohana Health Plan Medicare |
$42.35
|
| Rate for Payer: UnitedHealthcare Medicare |
$42.35
|
| Rate for Payer: University Health Alliance Commercial |
$34.30
|
|
|
TIMOLOL MALEATE 0.25 % OPHT DROP
|
Facility
|
IP
|
$19.77
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$19.18 |
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Health Management Network Commercial |
$16.80
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.79
|
| Rate for Payer: MDX Hawaii PPO |
$19.18
|
|
|
TIMOLOL MALEATE 0.25 % OPHT DROP
|
Facility
|
OP
|
$19.77
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$19.57 |
| Rate for Payer: AlohaCare Medicaid |
$9.88
|
| Rate for Payer: AlohaCare Medicare |
$17.79
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Devoted Health Medicare |
$19.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$17.79
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$18.78
|
| Rate for Payer: Health Management Network Commercial |
$16.80
|
| Rate for Payer: Humana Medicare |
$17.79
|
| Rate for Payer: Kaiser Permanente Commercial |
$17.79
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$17.79
|
| Rate for Payer: MDX Hawaii PPO |
$19.18
|
| Rate for Payer: Ohana Health Plan Medicaid |
$17.79
|
| Rate for Payer: Ohana Health Plan Medicare |
$17.79
|
| Rate for Payer: UnitedHealthcare Medicare |
$17.79
|
| Rate for Payer: University Health Alliance Commercial |
$14.41
|
|
|
TIMOLOL MALEATE 0.5 % OPHT DROP
|
Facility
|
OP
|
$88.38
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$44.19 |
| Max. Negotiated Rate |
$87.50 |
| Rate for Payer: AlohaCare Medicaid |
$44.19
|
| Rate for Payer: AlohaCare Medicaid |
$20.66
|
| Rate for Payer: AlohaCare Medicare |
$37.20
|
| Rate for Payer: AlohaCare Medicare |
$79.54
|
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$57.45
|
| Rate for Payer: Devoted Health Medicare |
$87.50
|
| Rate for Payer: Devoted Health Medicare |
$40.92
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$79.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.26
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.96
|
| Rate for Payer: Health Management Network Commercial |
$75.12
|
| Rate for Payer: Health Management Network Commercial |
$35.13
|
| Rate for Payer: Humana Medicare |
$79.54
|
| Rate for Payer: Humana Medicare |
$37.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.54
|
| Rate for Payer: Kaiser Permanente Medicaid |
$45.07
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.08
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.20
|
| Rate for Payer: Kaiser Permanente Medicare |
$79.54
|
| Rate for Payer: MDX Hawaii PPO |
$40.09
|
| Rate for Payer: MDX Hawaii PPO |
$85.73
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.20
|
| Rate for Payer: Ohana Health Plan Medicaid |
$79.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$79.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$79.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.20
|
| Rate for Payer: University Health Alliance Commercial |
$64.42
|
| Rate for Payer: University Health Alliance Commercial |
$30.13
|
|
|
TIMOLOL MALEATE 0.5 % OPHT DROP
|
Facility
|
IP
|
$41.33
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.13 |
| Max. Negotiated Rate |
$40.09 |
| Rate for Payer: Cash Price |
$26.86
|
| Rate for Payer: Cash Price |
$57.45
|
| Rate for Payer: Health Management Network Commercial |
$35.13
|
| Rate for Payer: Health Management Network Commercial |
$75.12
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$79.54
|
| Rate for Payer: MDX Hawaii PPO |
$85.73
|
| Rate for Payer: MDX Hawaii PPO |
$40.09
|
|
|
TIOTROPIUM BROMIDE 18 MCG INHAL CPDV
|
Facility
|
OP
|
$269.92
|
|
|
Service Code
|
HCPCS J3535
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.96 |
| Max. Negotiated Rate |
$267.22 |
| Rate for Payer: AlohaCare Medicaid |
$134.96
|
| Rate for Payer: AlohaCare Medicare |
$242.93
|
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Devoted Health Medicare |
$267.22
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$242.93
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$256.42
|
| Rate for Payer: Health Management Network Commercial |
$229.43
|
| Rate for Payer: Humana Medicare |
$242.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.93
|
| Rate for Payer: Kaiser Permanente Medicaid |
$137.66
|
| Rate for Payer: Kaiser Permanente Medicare |
$242.93
|
| Rate for Payer: MDX Hawaii PPO |
$261.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$242.93
|
| Rate for Payer: Ohana Health Plan Medicare |
$242.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$242.93
|
| Rate for Payer: University Health Alliance Commercial |
$196.74
|
|
|
TIOTROPIUM BROMIDE 18 MCG INHAL CPDV
|
Facility
|
IP
|
$269.92
|
|
|
Service Code
|
HCPCS J3535
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$229.43 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: Cash Price |
$175.45
|
| Rate for Payer: Health Management Network Commercial |
$229.43
|
| Rate for Payer: Kaiser Permanente Commercial |
$242.93
|
| Rate for Payer: MDX Hawaii PPO |
$261.82
|
|
|
TIOTROPIUM-OLODATEROL 2.5-2.5 MCG/ACTUATION INHAL MIST
|
Facility
|
IP
|
$328.50
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.23 |
| Max. Negotiated Rate |
$318.64 |
| Rate for Payer: Cash Price |
$213.52
|
| Rate for Payer: Health Management Network Commercial |
$279.23
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.65
|
| Rate for Payer: MDX Hawaii PPO |
$318.64
|
|
|
TIOTROPIUM-OLODATEROL 2.5-2.5 MCG/ACTUATION INHAL MIST
|
Facility
|
OP
|
$328.50
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$164.25 |
| Max. Negotiated Rate |
$325.21 |
| Rate for Payer: AlohaCare Medicaid |
$164.25
|
| Rate for Payer: AlohaCare Medicare |
$295.65
|
| Rate for Payer: Cash Price |
$213.52
|
| Rate for Payer: Devoted Health Medicare |
$325.21
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$295.65
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$312.07
|
| Rate for Payer: Health Management Network Commercial |
$279.23
|
| Rate for Payer: Humana Medicare |
$295.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$295.65
|
| Rate for Payer: Kaiser Permanente Medicaid |
$167.53
|
| Rate for Payer: Kaiser Permanente Medicare |
$295.65
|
| Rate for Payer: MDX Hawaii PPO |
$318.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$295.65
|
| Rate for Payer: Ohana Health Plan Medicare |
$295.65
|
| Rate for Payer: UnitedHealthcare Medicare |
$295.65
|
| Rate for Payer: University Health Alliance Commercial |
$239.44
|
|
|
TIZANIDINE 4 MG PO TABLET
|
Facility
|
IP
|
$8.36
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.11 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Health Management Network Commercial |
$7.11
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.52
|
| Rate for Payer: MDX Hawaii PPO |
$8.11
|
|
