|
ENOXAPARIN 120 MG/0.8 ML SUBCUTANEOUS SYR
|
Facility
|
IP
|
$111.15
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.48 |
| Max. Negotiated Rate |
$107.82 |
| Rate for Payer: Cash Price |
$72.25
|
| Rate for Payer: Health Management Network Commercial |
$94.48
|
| Rate for Payer: Kaiser Permanente Commercial |
$100.03
|
| Rate for Payer: MDX Hawaii PPO |
$107.82
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYR
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$22.77 |
| Rate for Payer: AlohaCare Medicaid |
$11.50
|
| Rate for Payer: AlohaCare Medicaid |
$12.42
|
| Rate for Payer: AlohaCare Medicaid |
$7.64
|
| Rate for Payer: AlohaCare Medicare |
$22.36
|
| Rate for Payer: AlohaCare Medicare |
$13.76
|
| Rate for Payer: AlohaCare Medicare |
$20.70
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Devoted Health Medicare |
$24.59
|
| Rate for Payer: Devoted Health Medicare |
$22.77
|
| Rate for Payer: Devoted Health Medicare |
$15.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$20.70
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.36
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$13.76
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.60
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$14.53
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$21.85
|
| Rate for Payer: Health Management Network Commercial |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Health Management Network Commercial |
$21.11
|
| Rate for Payer: Humana Medicare |
$20.70
|
| Rate for Payer: Humana Medicare |
$13.76
|
| Rate for Payer: Humana Medicare |
$22.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.76
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.73
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$7.80
|
| Rate for Payer: Kaiser Permanente Medicare |
$20.70
|
| Rate for Payer: Kaiser Permanente Medicare |
$13.76
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.36
|
| Rate for Payer: MDX Hawaii PPO |
$24.09
|
| Rate for Payer: MDX Hawaii PPO |
$14.83
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: Ohana Health Plan Medicaid |
$20.70
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.36
|
| Rate for Payer: Ohana Health Plan Medicaid |
$13.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.36
|
| Rate for Payer: Ohana Health Plan Medicare |
$13.76
|
| Rate for Payer: Ohana Health Plan Medicare |
$20.70
|
| Rate for Payer: UnitedHealthcare Medicaid |
$9.17
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.80
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.90
|
| Rate for Payer: UnitedHealthcare Medicare |
$13.76
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.36
|
| Rate for Payer: UnitedHealthcare Medicare |
$20.70
|
| Rate for Payer: University Health Alliance Commercial |
$18.11
|
| Rate for Payer: University Health Alliance Commercial |
$16.76
|
| Rate for Payer: University Health Alliance Commercial |
$11.14
|
|
|
ENOXAPARIN 30 MG/0.3 ML SUBCUTANEOUS SYR
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.55 |
| Max. Negotiated Rate |
$22.31 |
| Rate for Payer: Cash Price |
$14.95
|
| Rate for Payer: Cash Price |
$9.94
|
| Rate for Payer: Cash Price |
$16.15
|
| Rate for Payer: Health Management Network Commercial |
$21.11
|
| Rate for Payer: Health Management Network Commercial |
$13.00
|
| Rate for Payer: Health Management Network Commercial |
$19.55
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.36
|
| Rate for Payer: Kaiser Permanente Commercial |
$13.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$20.70
|
| Rate for Payer: MDX Hawaii PPO |
$22.31
|
| Rate for Payer: MDX Hawaii PPO |
$14.83
|
| Rate for Payer: MDX Hawaii PPO |
$24.09
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYR
|
Facility
|
OP
|
$20.32
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$20.12 |
| Rate for Payer: AlohaCare Medicaid |
$10.16
|
| Rate for Payer: AlohaCare Medicaid |
$25.45
|
| Rate for Payer: AlohaCare Medicare |
$45.81
|
| Rate for Payer: AlohaCare Medicare |
$18.29
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Devoted Health Medicare |
$20.12
|
| Rate for Payer: Devoted Health Medicare |
$50.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$45.81
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$18.29
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$19.30
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$48.35
|
| Rate for Payer: Health Management Network Commercial |
$43.27
|
| Rate for Payer: Health Management Network Commercial |
$17.27
|
| Rate for Payer: Humana Medicare |
$18.29
|
| Rate for Payer: Humana Medicare |
$45.81
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.81
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.96
|
| Rate for Payer: Kaiser Permanente Medicaid |
$10.36
|
| Rate for Payer: Kaiser Permanente Medicare |
$18.29
|
| Rate for Payer: Kaiser Permanente Medicare |
$45.81
|
| Rate for Payer: MDX Hawaii PPO |
$19.71
|
| Rate for Payer: MDX Hawaii PPO |
$49.37
|
| Rate for Payer: Ohana Health Plan Medicaid |
$45.81
|
| Rate for Payer: Ohana Health Plan Medicaid |
$18.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$18.29
|
| Rate for Payer: Ohana Health Plan Medicare |
$45.81
|
| Rate for Payer: UnitedHealthcare Medicaid |
$30.54
|
| Rate for Payer: UnitedHealthcare Medicaid |
$12.19
|
| Rate for Payer: UnitedHealthcare Medicare |
$18.29
|
| Rate for Payer: UnitedHealthcare Medicare |
$45.81
|
| Rate for Payer: University Health Alliance Commercial |
$14.81
|
| Rate for Payer: University Health Alliance Commercial |
$37.10
|
|
|
ENOXAPARIN 40 MG/0.4 ML SUBCUTANEOUS SYR
|
Facility
|
IP
|
$20.32
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$19.71 |
| Rate for Payer: Cash Price |
$13.21
|
| Rate for Payer: Cash Price |
$33.08
|
| Rate for Payer: Health Management Network Commercial |
$17.27
|
| Rate for Payer: Health Management Network Commercial |
$43.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$18.29
|
| Rate for Payer: Kaiser Permanente Commercial |
$45.81
|
| Rate for Payer: MDX Hawaii PPO |
$49.37
|
| Rate for Payer: MDX Hawaii PPO |
$19.71
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYR
|
Facility
|
IP
|
$87.41
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$84.79 |
| Rate for Payer: Cash Price |
$56.82
|
| Rate for Payer: Cash Price |
$34.53
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Health Management Network Commercial |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$74.30
|
| Rate for Payer: Health Management Network Commercial |
$45.16
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.68
|
| Rate for Payer: MDX Hawaii PPO |
$51.54
|
| Rate for Payer: MDX Hawaii PPO |
$28.76
|
| Rate for Payer: MDX Hawaii PPO |
$84.79
|
|
|
ENOXAPARIN 60 MG/0.6 ML SUBCUTANEOUS SYR
|
Facility
|
OP
|
$29.65
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$29.35 |
| Rate for Payer: AlohaCare Medicaid |
$14.82
|
| Rate for Payer: AlohaCare Medicaid |
$43.70
|
| Rate for Payer: AlohaCare Medicaid |
$26.57
|
| Rate for Payer: AlohaCare Medicare |
$47.82
|
| Rate for Payer: AlohaCare Medicare |
$26.68
|
| Rate for Payer: AlohaCare Medicare |
$78.67
|
| Rate for Payer: Cash Price |
$34.53
|
| Rate for Payer: Cash Price |
$56.82
|
| Rate for Payer: Cash Price |
$34.53
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$19.27
|
| Rate for Payer: Cash Price |
$56.82
|
| Rate for Payer: Devoted Health Medicare |
$29.35
|
| Rate for Payer: Devoted Health Medicare |
$86.54
|
| Rate for Payer: Devoted Health Medicare |
$52.60
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$26.68
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$78.67
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$47.82
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$50.47
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$28.17
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$83.04
|
| Rate for Payer: Health Management Network Commercial |
$74.30
|
| Rate for Payer: Health Management Network Commercial |
$25.20
|
| Rate for Payer: Health Management Network Commercial |
$45.16
|
| Rate for Payer: Humana Medicare |
$26.68
|
| Rate for Payer: Humana Medicare |
$47.82
|
| Rate for Payer: Humana Medicare |
$78.67
|
| Rate for Payer: Kaiser Permanente Commercial |
$26.68
|
| Rate for Payer: Kaiser Permanente Commercial |
$47.82
|
| Rate for Payer: Kaiser Permanente Commercial |
$78.67
|
| Rate for Payer: Kaiser Permanente Medicaid |
$44.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$27.10
|
| Rate for Payer: Kaiser Permanente Medicaid |
$15.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$26.68
|
| Rate for Payer: Kaiser Permanente Medicare |
$47.82
|
| Rate for Payer: Kaiser Permanente Medicare |
$78.67
|
| Rate for Payer: MDX Hawaii PPO |
$84.79
|
| Rate for Payer: MDX Hawaii PPO |
$51.54
|
| Rate for Payer: MDX Hawaii PPO |
$28.76
|
| Rate for Payer: Ohana Health Plan Medicaid |
$47.82
|
| Rate for Payer: Ohana Health Plan Medicaid |
$26.68
|
| Rate for Payer: Ohana Health Plan Medicaid |
$78.67
|
| Rate for Payer: Ohana Health Plan Medicare |
$47.82
|
| Rate for Payer: Ohana Health Plan Medicare |
$26.68
|
| Rate for Payer: Ohana Health Plan Medicare |
$78.67
|
| Rate for Payer: UnitedHealthcare Medicaid |
$31.88
|
| Rate for Payer: UnitedHealthcare Medicaid |
$17.79
|
| Rate for Payer: UnitedHealthcare Medicaid |
$52.45
|
| Rate for Payer: UnitedHealthcare Medicare |
$47.82
|
| Rate for Payer: UnitedHealthcare Medicare |
$26.68
|
| Rate for Payer: UnitedHealthcare Medicare |
$78.67
|
| Rate for Payer: University Health Alliance Commercial |
$21.61
|
| Rate for Payer: University Health Alliance Commercial |
$38.73
|
| Rate for Payer: University Health Alliance Commercial |
$63.71
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYR
|
Facility
|
IP
|
$45.39
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.58 |
| Max. Negotiated Rate |
$44.03 |
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Health Management Network Commercial |
$38.58
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.85
|
| Rate for Payer: MDX Hawaii PPO |
$44.03
|
|
|
ENOXAPARIN 80 MG/0.8 ML SUBCUTANEOUS SYR
|
Facility
|
OP
|
$45.39
|
|
|
Service Code
|
HCPCS J1650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$44.94 |
| Rate for Payer: AlohaCare Medicaid |
$22.70
|
| Rate for Payer: AlohaCare Medicare |
$40.85
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Cash Price |
$29.50
|
| Rate for Payer: Devoted Health Medicare |
$44.94
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.24
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$40.85
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$43.12
|
| Rate for Payer: Health Management Network Commercial |
$38.58
|
| Rate for Payer: Humana Medicare |
$40.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$40.85
|
| Rate for Payer: Kaiser Permanente Medicaid |
$23.15
|
| Rate for Payer: Kaiser Permanente Medicare |
$40.85
|
| Rate for Payer: MDX Hawaii PPO |
$44.03
|
| Rate for Payer: Ohana Health Plan Medicaid |
$40.85
|
| Rate for Payer: Ohana Health Plan Medicare |
$40.85
|
| Rate for Payer: UnitedHealthcare Medicaid |
$27.23
|
| Rate for Payer: UnitedHealthcare Medicare |
$40.85
|
| Rate for Payer: University Health Alliance Commercial |
$33.08
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION (NOT FOR EYES, CONTAINS TARTARIC ACID)
|
Facility
|
OP
|
$49.26
|
|
|
Service Code
|
HCPCS J0169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$48.77 |
| Rate for Payer: AlohaCare Medicaid |
$24.63
|
| Rate for Payer: AlohaCare Medicare |
$44.33
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Devoted Health Medicare |
$48.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$41.87
|
| Rate for Payer: Humana Medicare |
$44.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.33
|
| Rate for Payer: MDX Hawaii PPO |
$47.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.33
|
| Rate for Payer: University Health Alliance Commercial |
$35.91
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJECTION (NOT FOR EYES, CONTAINS TARTARIC ACID)
|
Facility
|
IP
|
$49.26
|
|
|
Service Code
|
HCPCS J0169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$47.78 |
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Health Management Network Commercial |
$41.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.33
|
| Rate for Payer: MDX Hawaii PPO |
$47.78
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN
|
Facility
|
IP
|
$49.26
|
|
|
Service Code
|
HCPCS J0169
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$47.78 |
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Health Management Network Commercial |
$41.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.33
|
| Rate for Payer: MDX Hawaii PPO |
$47.78
|
|
|
EPINEPHRINE 1 MG/ML (1 ML) INJ SOLN
|
Facility
|
OP
|
$49.26
|
|
|
Service Code
|
HCPCS J0169
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$48.77 |
| Rate for Payer: AlohaCare Medicaid |
$24.63
|
| Rate for Payer: AlohaCare Medicare |
$44.33
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Cash Price |
$32.02
|
| Rate for Payer: Devoted Health Medicare |
$48.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.32
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$44.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.32
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network Commercial |
$41.87
|
| Rate for Payer: Humana Medicare |
$44.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$44.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$25.12
|
| Rate for Payer: Kaiser Permanente Medicare |
$44.33
|
| Rate for Payer: MDX Hawaii PPO |
$47.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$44.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$44.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$29.56
|
| Rate for Payer: UnitedHealthcare Medicare |
$44.33
|
| Rate for Payer: University Health Alliance Commercial |
$35.91
|
|
|
EPINEPHRINE HCL 0.1 MG/ML INTRACARDIAC SYRINGE
|
Facility
|
OP
|
$74.89
|
|
|
Service Code
|
HCPCS J0168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.18 |
| Max. Negotiated Rate |
$74.14 |
| Rate for Payer: AlohaCare Medicaid |
$37.45
|
| Rate for Payer: AlohaCare Medicare |
$67.40
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Devoted Health Medicare |
$74.14
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$2.18
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$67.40
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$2.18
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$71.15
|
| Rate for Payer: Health Management Network Commercial |
$63.66
|
| Rate for Payer: Humana Medicare |
$67.40
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.40
|
| Rate for Payer: Kaiser Permanente Medicaid |
$38.19
|
| Rate for Payer: Kaiser Permanente Medicare |
$67.40
|
| Rate for Payer: MDX Hawaii PPO |
$72.64
|
| Rate for Payer: Ohana Health Plan Medicaid |
$67.40
|
| Rate for Payer: Ohana Health Plan Medicare |
$67.40
|
| Rate for Payer: UnitedHealthcare Medicaid |
$44.93
|
| Rate for Payer: UnitedHealthcare Medicare |
$67.40
|
| Rate for Payer: University Health Alliance Commercial |
$54.59
|
|
|
EPINEPHRINE HCL 0.1 MG/ML INTRACARDIAC SYRINGE
|
Facility
|
IP
|
$74.89
|
|
|
Service Code
|
HCPCS J0168
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$63.66 |
| Max. Negotiated Rate |
$72.64 |
| Rate for Payer: Cash Price |
$48.68
|
| Rate for Payer: Health Management Network Commercial |
$63.66
|
| Rate for Payer: Kaiser Permanente Commercial |
$67.40
|
| Rate for Payer: MDX Hawaii PPO |
$72.64
|
|
|
EPINEPHRINE IN 0.9 % SOD CHLOR 4 MG/250 ML (16 MCG/ML) IV SOLN
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
HCPCS J0163
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$156.06 |
| Max. Negotiated Rate |
$178.09 |
| Rate for Payer: Cash Price |
$119.34
|
| Rate for Payer: Health Management Network Commercial |
$156.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.24
|
| Rate for Payer: MDX Hawaii PPO |
$178.09
|
|
|
EPINEPHRINE IN 0.9 % SOD CHLOR 4 MG/250 ML (16 MCG/ML) IV SOLN
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
HCPCS J0163
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.80 |
| Max. Negotiated Rate |
$181.76 |
| Rate for Payer: AlohaCare Medicaid |
$91.80
|
| Rate for Payer: AlohaCare Medicare |
$165.24
|
| Rate for Payer: Cash Price |
$119.34
|
| Rate for Payer: Devoted Health Medicare |
$181.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$165.24
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$174.42
|
| Rate for Payer: Health Management Network Commercial |
$156.06
|
| Rate for Payer: Humana Medicare |
$165.24
|
| Rate for Payer: Kaiser Permanente Commercial |
$165.24
|
| Rate for Payer: Kaiser Permanente Medicaid |
$93.64
|
| Rate for Payer: Kaiser Permanente Medicare |
$165.24
|
| Rate for Payer: MDX Hawaii PPO |
$178.09
|
| Rate for Payer: Ohana Health Plan Medicaid |
$165.24
|
| Rate for Payer: Ohana Health Plan Medicare |
$165.24
|
| Rate for Payer: UnitedHealthcare Medicaid |
$110.16
|
| Rate for Payer: UnitedHealthcare Medicare |
$165.24
|
| Rate for Payer: University Health Alliance Commercial |
$133.83
|
|
|
EPISTAXIS WITH MCC
|
Facility
|
IP
|
$10,405.18
|
|
|
Service Code
|
MSDRG 150
|
| Min. Negotiated Rate |
$10,405.18 |
| Max. Negotiated Rate |
$10,405.18 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,405.18
|
|
|
EPISTAXIS WITHOUT MCC
|
Facility
|
IP
|
$10,405.18
|
|
|
Service Code
|
MSDRG 151
|
| Min. Negotiated Rate |
$10,405.18 |
| Max. Negotiated Rate |
$10,405.18 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$10,405.18
|
|
|
EPOETIN ALFA-EPBX 10000 UNITS/ML INJ SOLN
|
Facility
|
IP
|
$468.99
|
|
|
Service Code
|
HCPCS Q5106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$398.64 |
| Max. Negotiated Rate |
$454.92 |
| Rate for Payer: Cash Price |
$304.84
|
| Rate for Payer: Health Management Network Commercial |
$398.64
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.09
|
| Rate for Payer: MDX Hawaii PPO |
$454.92
|
|
|
EPOETIN ALFA-EPBX 10000 UNITS/ML INJ SOLN
|
Facility
|
OP
|
$468.99
|
|
|
Service Code
|
HCPCS Q5106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$464.30 |
| Rate for Payer: AlohaCare Medicaid |
$234.50
|
| Rate for Payer: AlohaCare Medicare |
$422.09
|
| Rate for Payer: Cash Price |
$304.84
|
| Rate for Payer: Cash Price |
$304.84
|
| Rate for Payer: Devoted Health Medicare |
$464.30
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$7.57
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$9.85
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$422.09
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$7.57
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$445.54
|
| Rate for Payer: Health Management Network Commercial |
$398.64
|
| Rate for Payer: Humana Medicare |
$422.09
|
| Rate for Payer: Kaiser Permanente Commercial |
$422.09
|
| Rate for Payer: Kaiser Permanente Medicaid |
$239.18
|
| Rate for Payer: Kaiser Permanente Medicare |
$422.09
|
| Rate for Payer: MDX Hawaii PPO |
$454.92
|
| Rate for Payer: Ohana Health Plan Medicaid |
$422.09
|
| Rate for Payer: Ohana Health Plan Medicare |
$422.09
|
| Rate for Payer: UnitedHealthcare Medicaid |
$281.39
|
| Rate for Payer: UnitedHealthcare Medicare |
$422.09
|
| Rate for Payer: University Health Alliance Commercial |
$341.85
|
|
|
EPTIFIBATIDE 2 MG/ML IV SOLN
|
Facility
|
OP
|
$629.34
|
|
|
Service Code
|
HCPCS J1327
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$623.05 |
| Rate for Payer: AlohaCare Medicaid |
$314.67
|
| Rate for Payer: AlohaCare Medicare |
$566.41
|
| Rate for Payer: Cash Price |
$409.07
|
| Rate for Payer: Cash Price |
$409.07
|
| Rate for Payer: Devoted Health Medicare |
$623.05
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$4.08
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$566.41
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$597.87
|
| Rate for Payer: Health Management Network Commercial |
$534.94
|
| Rate for Payer: Humana Medicare |
$566.41
|
| Rate for Payer: Kaiser Permanente Commercial |
$566.41
|
| Rate for Payer: Kaiser Permanente Medicaid |
$320.96
|
| Rate for Payer: Kaiser Permanente Medicare |
$566.41
|
| Rate for Payer: MDX Hawaii PPO |
$610.46
|
| Rate for Payer: Ohana Health Plan Medicaid |
$566.41
|
| Rate for Payer: Ohana Health Plan Medicare |
$566.41
|
| Rate for Payer: UnitedHealthcare Medicaid |
$377.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$566.41
|
| Rate for Payer: University Health Alliance Commercial |
$458.73
|
|
|
EPTIFIBATIDE 2 MG/ML IV SOLN
|
Facility
|
IP
|
$629.34
|
|
|
Service Code
|
HCPCS J1327
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$534.94 |
| Max. Negotiated Rate |
$610.46 |
| Rate for Payer: Cash Price |
$409.07
|
| Rate for Payer: Health Management Network Commercial |
$534.94
|
| Rate for Payer: Kaiser Permanente Commercial |
$566.41
|
| Rate for Payer: MDX Hawaii PPO |
$610.46
|
|
|
ERAVACYCLINE 100 MG IV RECON.SOLN.
|
Facility
|
OP
|
$482.21
|
|
|
Service Code
|
HCPCS J0122
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$477.39 |
| Rate for Payer: AlohaCare Medicaid |
$241.10
|
| Rate for Payer: AlohaCare Medicare |
$433.99
|
| Rate for Payer: Cash Price |
$313.44
|
| Rate for Payer: Cash Price |
$313.44
|
| Rate for Payer: Devoted Health Medicare |
$477.39
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$1.29
|
| Rate for Payer: Hawaii Medical Service Association Commercial |
$1.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$433.99
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$1.29
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$458.10
|
| Rate for Payer: Health Management Network Commercial |
$409.88
|
| Rate for Payer: Humana Medicare |
$433.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$433.99
|
| Rate for Payer: Kaiser Permanente Medicaid |
$245.93
|
| Rate for Payer: Kaiser Permanente Medicare |
$433.99
|
| Rate for Payer: MDX Hawaii PPO |
$467.74
|
| Rate for Payer: Ohana Health Plan Medicaid |
$433.99
|
| Rate for Payer: Ohana Health Plan Medicare |
$433.99
|
| Rate for Payer: UnitedHealthcare Medicaid |
$289.33
|
| Rate for Payer: UnitedHealthcare Medicare |
$433.99
|
| Rate for Payer: University Health Alliance Commercial |
$351.48
|
|
|
ERAVACYCLINE 100 MG IV RECON.SOLN.
|
Facility
|
IP
|
$482.21
|
|
|
Service Code
|
HCPCS J0122
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$409.88 |
| Max. Negotiated Rate |
$467.74 |
| Rate for Payer: Cash Price |
$313.44
|
| Rate for Payer: Health Management Network Commercial |
$409.88
|
| Rate for Payer: Kaiser Permanente Commercial |
$433.99
|
| Rate for Payer: MDX Hawaii PPO |
$467.74
|
|
