|
TIZANIDINE 4 MG PO TABLET
|
Facility
|
OP
|
$8.36
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.18 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: AlohaCare Medicaid |
$4.18
|
| Rate for Payer: AlohaCare Medicare |
$7.52
|
| Rate for Payer: Cash Price |
$5.43
|
| Rate for Payer: Devoted Health Medicare |
$8.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$7.52
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$7.94
|
| Rate for Payer: Health Management Network Commercial |
$7.11
|
| Rate for Payer: Humana Medicare |
$7.52
|
| Rate for Payer: Kaiser Permanente Commercial |
$7.52
|
| Rate for Payer: Kaiser Permanente Medicaid |
$4.26
|
| Rate for Payer: Kaiser Permanente Medicare |
$7.52
|
| Rate for Payer: MDX Hawaii PPO |
$8.11
|
| Rate for Payer: Ohana Health Plan Medicaid |
$7.52
|
| Rate for Payer: Ohana Health Plan Medicare |
$7.52
|
| Rate for Payer: UnitedHealthcare Medicare |
$7.52
|
| Rate for Payer: University Health Alliance Commercial |
$6.09
|
|
|
TOBRAMYCIN 0.3 % OPHT DROP
|
Facility
|
IP
|
$158.76
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$134.95 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: Cash Price |
$103.19
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Health Management Network Commercial |
$134.95
|
| Rate for Payer: Health Management Network Commercial |
$33.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.85
|
| Rate for Payer: MDX Hawaii PPO |
$38.64
|
| Rate for Payer: MDX Hawaii PPO |
$154.00
|
|
|
TOBRAMYCIN 0.3 % OPHT DROP
|
Facility
|
OP
|
$39.83
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.91 |
| Max. Negotiated Rate |
$39.43 |
| Rate for Payer: AlohaCare Medicaid |
$19.91
|
| Rate for Payer: AlohaCare Medicaid |
$79.38
|
| Rate for Payer: AlohaCare Medicare |
$142.88
|
| Rate for Payer: AlohaCare Medicare |
$35.85
|
| Rate for Payer: Cash Price |
$103.19
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Devoted Health Medicare |
$39.43
|
| Rate for Payer: Devoted Health Medicare |
$157.17
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$142.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.85
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$150.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.84
|
| Rate for Payer: Health Management Network Commercial |
$33.86
|
| Rate for Payer: Health Management Network Commercial |
$134.95
|
| Rate for Payer: Humana Medicare |
$35.85
|
| Rate for Payer: Humana Medicare |
$142.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$142.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.31
|
| Rate for Payer: Kaiser Permanente Medicaid |
$80.97
|
| Rate for Payer: Kaiser Permanente Medicare |
$142.88
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.85
|
| Rate for Payer: MDX Hawaii PPO |
$154.00
|
| Rate for Payer: MDX Hawaii PPO |
$38.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$142.88
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$142.88
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.85
|
| Rate for Payer: UnitedHealthcare Medicare |
$142.88
|
| Rate for Payer: University Health Alliance Commercial |
$29.03
|
| Rate for Payer: University Health Alliance Commercial |
$115.72
|
|
|
TOBRAMYCIN 0.3 % OPHT OINT
|
Facility
|
IP
|
$821.28
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$698.09 |
| Max. Negotiated Rate |
$796.64 |
| Rate for Payer: Cash Price |
$533.83
|
| Rate for Payer: Health Management Network Commercial |
$698.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$739.15
|
| Rate for Payer: MDX Hawaii PPO |
$796.64
|
|
|
TOBRAMYCIN 0.3 % OPHT OINT
|
Facility
|
OP
|
$821.28
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$410.64 |
| Max. Negotiated Rate |
$813.07 |
| Rate for Payer: AlohaCare Medicaid |
$410.64
|
| Rate for Payer: AlohaCare Medicare |
$739.15
|
| Rate for Payer: Cash Price |
$533.83
|
| Rate for Payer: Devoted Health Medicare |
$813.07
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$739.15
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$780.22
|
| Rate for Payer: Health Management Network Commercial |
$698.09
|
| Rate for Payer: Humana Medicare |
$739.15
|
| Rate for Payer: Kaiser Permanente Commercial |
$739.15
|
| Rate for Payer: Kaiser Permanente Medicaid |
$418.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$739.15
|
| Rate for Payer: MDX Hawaii PPO |
$796.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$739.15
|
| Rate for Payer: Ohana Health Plan Medicare |
$739.15
|
| Rate for Payer: UnitedHealthcare Medicare |
$739.15
|
| Rate for Payer: University Health Alliance Commercial |
$598.63
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS
|
Facility
|
OP
|
$541.94
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$270.97 |
| Max. Negotiated Rate |
$536.52 |
| Rate for Payer: AlohaCare Medicaid |
$270.97
|
| Rate for Payer: AlohaCare Medicare |
$487.75
|
| Rate for Payer: Cash Price |
$352.26
|
| Rate for Payer: Devoted Health Medicare |
$536.52
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$487.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$514.84
|
| Rate for Payer: Health Management Network Commercial |
$460.65
|
| Rate for Payer: Humana Medicare |
$487.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$487.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$276.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$487.75
|
| Rate for Payer: MDX Hawaii PPO |
$525.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$487.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$487.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$487.75
|
| Rate for Payer: University Health Alliance Commercial |
$395.02
|
|
|
TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS
|
Facility
|
IP
|
$541.94
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$460.65 |
| Max. Negotiated Rate |
$525.68 |
| Rate for Payer: Cash Price |
$352.26
|
| Rate for Payer: Health Management Network Commercial |
$460.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$487.75
|
| Rate for Payer: MDX Hawaii PPO |
$525.68
|
|
|
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN
|
Facility
|
IP
|
$16.48
|
|
|
Service Code
|
HCPCS J3260
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$15.99 |
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Health Management Network Commercial |
$14.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.83
|
| Rate for Payer: MDX Hawaii PPO |
$15.99
|
|
|
TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN
|
Facility
|
OP
|
$16.48
|
|
|
Service Code
|
HCPCS J3260
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: AlohaCare Medicaid |
$8.24
|
| Rate for Payer: AlohaCare Medicare |
$14.83
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Cash Price |
$10.71
|
| Rate for Payer: Devoted Health Medicare |
$16.32
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$14.83
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$15.66
|
| Rate for Payer: Health Management Network Commercial |
$14.01
|
| Rate for Payer: Humana Medicare |
$14.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$14.83
|
| Rate for Payer: Kaiser Permanente Medicaid |
$8.40
|
| Rate for Payer: Kaiser Permanente Medicare |
$14.83
|
| Rate for Payer: MDX Hawaii PPO |
$15.99
|
| Rate for Payer: Ohana Health Plan Medicaid |
$14.83
|
| Rate for Payer: Ohana Health Plan Medicare |
$14.83
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$14.83
|
| Rate for Payer: University Health Alliance Commercial |
$12.01
|
|
|
TOLTERODINE 2 MG PO CAP SR 24HR
|
Facility
|
IP
|
$72.40
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.54 |
| Max. Negotiated Rate |
$70.23 |
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Health Management Network Commercial |
$61.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.16
|
| Rate for Payer: MDX Hawaii PPO |
$70.23
|
|
|
TOLTERODINE 2 MG PO CAP SR 24HR
|
Facility
|
OP
|
$72.40
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$71.68 |
| Rate for Payer: AlohaCare Medicaid |
$36.20
|
| Rate for Payer: AlohaCare Medicare |
$65.16
|
| Rate for Payer: Cash Price |
$47.06
|
| Rate for Payer: Devoted Health Medicare |
$71.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.16
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$68.78
|
| Rate for Payer: Health Management Network Commercial |
$61.54
|
| Rate for Payer: Humana Medicare |
$65.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.16
|
| Rate for Payer: Kaiser Permanente Medicaid |
$36.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.16
|
| Rate for Payer: MDX Hawaii PPO |
$70.23
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.16
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.16
|
| Rate for Payer: University Health Alliance Commercial |
$52.77
|
|
|
TOPIRAMATE 100 MG PO TABLET
|
Facility
|
IP
|
$39.59
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$38.40 |
| Rate for Payer: Cash Price |
$25.73
|
| Rate for Payer: Health Management Network Commercial |
$33.65
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.63
|
| Rate for Payer: MDX Hawaii PPO |
$38.40
|
|
|
TOPIRAMATE 100 MG PO TABLET
|
Facility
|
OP
|
$39.59
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.80 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: AlohaCare Medicaid |
$19.80
|
| Rate for Payer: AlohaCare Medicare |
$35.63
|
| Rate for Payer: Cash Price |
$25.73
|
| Rate for Payer: Devoted Health Medicare |
$39.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$35.63
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$37.61
|
| Rate for Payer: Health Management Network Commercial |
$33.65
|
| Rate for Payer: Humana Medicare |
$35.63
|
| Rate for Payer: Kaiser Permanente Commercial |
$35.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$20.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$35.63
|
| Rate for Payer: MDX Hawaii PPO |
$38.40
|
| Rate for Payer: Ohana Health Plan Medicaid |
$35.63
|
| Rate for Payer: Ohana Health Plan Medicare |
$35.63
|
| Rate for Payer: UnitedHealthcare Medicare |
$35.63
|
| Rate for Payer: University Health Alliance Commercial |
$28.86
|
|
|
TOPIRAMATE 25 MG PO TABLET
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: AlohaCare Medicaid |
$5.80
|
| Rate for Payer: AlohaCare Medicare |
$10.44
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Devoted Health Medicare |
$11.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.02
|
| Rate for Payer: Health Management Network Commercial |
$9.86
|
| Rate for Payer: Humana Medicare |
$10.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.44
|
| Rate for Payer: MDX Hawaii PPO |
$11.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.44
|
| Rate for Payer: University Health Alliance Commercial |
$8.46
|
|
|
TOPIRAMATE 25 MG PO TABLET
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Health Management Network Commercial |
$9.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.44
|
| Rate for Payer: MDX Hawaii PPO |
$11.25
|
|
|
TOPIRAMATE 25 MG PO TABLET (0.5 TAB) = 12.5 MG
|
Facility
|
IP
|
$11.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.86 |
| Max. Negotiated Rate |
$11.25 |
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Health Management Network Commercial |
$9.86
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.44
|
| Rate for Payer: MDX Hawaii PPO |
$11.25
|
|
|
TOPIRAMATE 25 MG PO TABLET (0.5 TAB) = 12.5 MG
|
Facility
|
OP
|
$11.60
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: AlohaCare Medicaid |
$5.80
|
| Rate for Payer: AlohaCare Medicare |
$10.44
|
| Rate for Payer: Cash Price |
$7.54
|
| Rate for Payer: Devoted Health Medicare |
$11.48
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$10.44
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$11.02
|
| Rate for Payer: Health Management Network Commercial |
$9.86
|
| Rate for Payer: Humana Medicare |
$10.44
|
| Rate for Payer: Kaiser Permanente Commercial |
$10.44
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.92
|
| Rate for Payer: Kaiser Permanente Medicare |
$10.44
|
| Rate for Payer: MDX Hawaii PPO |
$11.25
|
| Rate for Payer: Ohana Health Plan Medicaid |
$10.44
|
| Rate for Payer: Ohana Health Plan Medicare |
$10.44
|
| Rate for Payer: UnitedHealthcare Medicare |
$10.44
|
| Rate for Payer: University Health Alliance Commercial |
$8.46
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC
|
Facility
|
IP
|
$83,122.91
|
|
|
Service Code
|
MSDRG 012
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$83,122.91 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83,122.91
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC
|
Facility
|
IP
|
$83,122.91
|
|
|
Service Code
|
MSDRG 011
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$83,122.91 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83,122.91
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$83,122.91
|
|
|
Service Code
|
MSDRG 013
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$83,122.91 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$83,122.91
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$404,593.14
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$10,400.00 |
| Max. Negotiated Rate |
$404,593.14 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$404,593.14
|
| Rate for Payer: University Health Alliance Commercial |
$10,400.00
|
|
|
TRAMADOL 50 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 Medicare |
$1.08
|
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Devoted Health Medicare |
$1.19
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$1.08
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1.14
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Humana Medicare |
$1.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: Kaiser Permanente Medicaid |
$0.61
|
| Rate for Payer: Kaiser Permanente Medicare |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$1.08
|
| Rate for Payer: Ohana Health Plan Medicare |
$1.08
|
| Rate for Payer: UnitedHealthcare Medicare |
$1.08
|
| Rate for Payer: University Health Alliance Commercial |
$0.87
|
|
|
TRAMADOL 50 MG PO TABLET
|
Facility
|
IP
|
$1.20
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.16 |
| Rate for Payer: Cash Price |
$0.78
|
| Rate for Payer: Health Management Network Commercial |
$1.02
|
| Rate for Payer: Kaiser Permanente Commercial |
$1.08
|
| Rate for Payer: MDX Hawaii PPO |
$1.16
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN
|
Facility
|
OP
|
$38.62
|
|
|
Service Code
|
HCPCS J3290
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.31 |
| Max. Negotiated Rate |
$38.23 |
| Rate for Payer: AlohaCare Medicaid |
$19.31
|
| Rate for Payer: AlohaCare Medicaid |
$16.01
|
| Rate for Payer: AlohaCare Medicaid |
$10.54
|
| Rate for Payer: AlohaCare Medicaid |
$20.76
|
| Rate for Payer: AlohaCare Medicare |
$34.76
|
| Rate for Payer: AlohaCare Medicare |
$37.37
|
| Rate for Payer: AlohaCare Medicare |
$28.82
|
| Rate for Payer: AlohaCare Medicare |
$18.98
|
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Devoted Health Medicare |
$31.70
|
| Rate for Payer: Devoted Health Medicare |
$38.23
|
| Rate for Payer: Devoted Health Medicare |
$41.10
|
| Rate for Payer: Devoted Health Medicare |
$20.88
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.98
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$37.37
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$34.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$28.82
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.04
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$36.69
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$30.42
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$39.44
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$32.83
|
| Rate for Payer: Health Management Network Commercial |
$17.93
|
| Rate for Payer: Humana Medicare |
$37.37
|
| Rate for Payer: Humana Medicare |
$28.82
|
| Rate for Payer: Humana Medicare |
$34.76
|
| Rate for Payer: Humana Medicare |
$18.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.98
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.37
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$16.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$21.18
|
| Rate for Payer: Kaiser Permanente Medicaid |
$19.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$28.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.98
|
| Rate for Payer: Kaiser Permanente Medicare |
$34.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$37.37
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: MDX Hawaii PPO |
$20.46
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
| Rate for Payer: MDX Hawaii PPO |
$37.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$34.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$37.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.98
|
| Rate for Payer: Ohana Health Plan Medicaid |
$28.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$34.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$37.37
|
| Rate for Payer: Ohana Health Plan Medicare |
$28.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.98
|
| Rate for Payer: UnitedHealthcare Medicaid |
$24.91
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.65
|
| Rate for Payer: UnitedHealthcare Medicaid |
$19.21
|
| Rate for Payer: UnitedHealthcare Medicaid |
$23.17
|
| Rate for Payer: UnitedHealthcare Medicare |
$34.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$37.37
|
| Rate for Payer: UnitedHealthcare Medicare |
$28.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.98
|
| Rate for Payer: University Health Alliance Commercial |
$30.26
|
| Rate for Payer: University Health Alliance Commercial |
$15.37
|
| Rate for Payer: University Health Alliance Commercial |
$23.34
|
| Rate for Payer: University Health Alliance Commercial |
$28.15
|
|
|
TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN
|
Facility
|
IP
|
$21.09
|
|
|
Service Code
|
HCPCS J3290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$20.46 |
| Rate for Payer: Cash Price |
$25.10
|
| Rate for Payer: Cash Price |
$13.71
|
| Rate for Payer: Cash Price |
$20.81
|
| Rate for Payer: Cash Price |
$26.99
|
| Rate for Payer: Health Management Network Commercial |
$27.22
|
| Rate for Payer: Health Management Network Commercial |
$32.83
|
| Rate for Payer: Health Management Network Commercial |
$35.29
|
| Rate for Payer: Health Management Network Commercial |
$17.93
|
| Rate for Payer: Kaiser Permanente Commercial |
$34.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$28.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$37.37
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.98
|
| Rate for Payer: MDX Hawaii PPO |
$40.27
|
| Rate for Payer: MDX Hawaii PPO |
$31.06
|
| Rate for Payer: MDX Hawaii PPO |
$20.46
|
| Rate for Payer: MDX Hawaii PPO |
$37.46
|
|
