|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) PO CAP
|
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 |
$1.99
|
| Rate for Payer: AlohaCare Medicare |
$9.54
|
| Rate for Payer: AlohaCare Medicare |
$3.57
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Devoted Health Medicare |
$10.49
|
| Rate for Payer: Devoted Health Medicare |
$3.93
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$3.57
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$9.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$3.77
|
| 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 |
$3.37
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: Humana Medicare |
$9.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.54
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.57
|
| Rate for Payer: Kaiser Permanente Medicaid |
$2.02
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$3.57
|
| Rate for Payer: Kaiser Permanente Medicare |
$9.54
|
| Rate for Payer: MDX Hawaii PPO |
$3.85
|
| Rate for Payer: MDX Hawaii PPO |
$10.28
|
| Rate for Payer: Ohana Health Plan Medicaid |
$9.54
|
| Rate for Payer: Ohana Health Plan Medicaid |
$3.57
|
| Rate for Payer: Ohana Health Plan Medicare |
$9.54
|
| Rate for Payer: Ohana Health Plan Medicare |
$3.57
|
| Rate for Payer: UnitedHealthcare Medicare |
$9.54
|
| Rate for Payer: UnitedHealthcare Medicare |
$3.57
|
| Rate for Payer: University Health Alliance Commercial |
$2.89
|
| Rate for Payer: University Health Alliance Commercial |
$7.73
|
|
|
ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) PO CAP
|
Facility
|
IP
|
$3.97
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.37 |
| Max. Negotiated Rate |
$3.85 |
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$6.89
|
| Rate for Payer: Health Management Network Commercial |
$3.37
|
| Rate for Payer: Health Management Network Commercial |
$9.01
|
| Rate for Payer: Kaiser Permanente Commercial |
$3.57
|
| Rate for Payer: Kaiser Permanente Commercial |
$9.54
|
| Rate for Payer: MDX Hawaii PPO |
$10.28
|
| Rate for Payer: MDX Hawaii PPO |
$3.85
|
|
|
ERTAPENEM 1 GRAM INJ RECON.SOLN.
|
Facility
|
IP
|
$585.78
|
|
|
Service Code
|
HCPCS J1335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$497.91 |
| Max. Negotiated Rate |
$568.21 |
| Rate for Payer: Cash Price |
$380.76
|
| Rate for Payer: Cash Price |
$226.49
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Health Management Network Commercial |
$85.68
|
| Rate for Payer: Health Management Network Commercial |
$497.91
|
| Rate for Payer: Health Management Network Commercial |
$296.17
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$527.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: MDX Hawaii PPO |
$337.99
|
| Rate for Payer: MDX Hawaii PPO |
$97.78
|
| Rate for Payer: MDX Hawaii PPO |
$568.21
|
|
|
ERTAPENEM 1 GRAM INJ RECON.SOLN.
|
Facility
|
OP
|
$100.80
|
|
|
Service Code
|
HCPCS J1335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$99.79 |
| Rate for Payer: AlohaCare Medicaid |
$50.40
|
| Rate for Payer: AlohaCare Medicaid |
$292.89
|
| Rate for Payer: AlohaCare Medicaid |
$174.22
|
| Rate for Payer: AlohaCare Medicare |
$313.60
|
| Rate for Payer: AlohaCare Medicare |
$90.72
|
| Rate for Payer: AlohaCare Medicare |
$527.20
|
| Rate for Payer: Cash Price |
$226.49
|
| Rate for Payer: Cash Price |
$380.76
|
| Rate for Payer: Cash Price |
$226.49
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$65.52
|
| Rate for Payer: Cash Price |
$380.76
|
| Rate for Payer: Devoted Health Medicare |
$99.79
|
| Rate for Payer: Devoted Health Medicare |
$579.92
|
| Rate for Payer: Devoted Health Medicare |
$344.96
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.71
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$59.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$90.72
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$527.20
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$313.60
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.71
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$59.71
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$331.02
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$95.76
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$556.49
|
| Rate for Payer: Health Management Network Commercial |
$497.91
|
| Rate for Payer: Health Management Network Commercial |
$85.68
|
| Rate for Payer: Health Management Network Commercial |
$296.17
|
| Rate for Payer: Humana Medicare |
$90.72
|
| Rate for Payer: Humana Medicare |
$313.60
|
| Rate for Payer: Humana Medicare |
$527.20
|
| Rate for Payer: Kaiser Permanente Commercial |
$90.72
|
| Rate for Payer: Kaiser Permanente Commercial |
$313.60
|
| Rate for Payer: Kaiser Permanente Commercial |
$527.20
|
| Rate for Payer: Kaiser Permanente Medicaid |
$298.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$177.70
|
| Rate for Payer: Kaiser Permanente Medicaid |
$51.41
|
| Rate for Payer: Kaiser Permanente Medicare |
$90.72
|
| Rate for Payer: Kaiser Permanente Medicare |
$313.60
|
| Rate for Payer: Kaiser Permanente Medicare |
$527.20
|
| Rate for Payer: MDX Hawaii PPO |
$568.21
|
| Rate for Payer: MDX Hawaii PPO |
$337.99
|
| Rate for Payer: MDX Hawaii PPO |
$97.78
|
| Rate for Payer: Ohana Health Plan Medicaid |
$313.60
|
| Rate for Payer: Ohana Health Plan Medicaid |
$90.72
|
| Rate for Payer: Ohana Health Plan Medicaid |
$527.20
|
| Rate for Payer: Ohana Health Plan Medicare |
$313.60
|
| Rate for Payer: Ohana Health Plan Medicare |
$90.72
|
| Rate for Payer: Ohana Health Plan Medicare |
$527.20
|
| Rate for Payer: UnitedHealthcare Medicaid |
$209.06
|
| Rate for Payer: UnitedHealthcare Medicaid |
$60.48
|
| Rate for Payer: UnitedHealthcare Medicaid |
$351.47
|
| Rate for Payer: UnitedHealthcare Medicare |
$313.60
|
| Rate for Payer: UnitedHealthcare Medicare |
$90.72
|
| Rate for Payer: UnitedHealthcare Medicare |
$527.20
|
| Rate for Payer: University Health Alliance Commercial |
$73.47
|
| Rate for Payer: University Health Alliance Commercial |
$253.98
|
| Rate for Payer: University Health Alliance Commercial |
$426.98
|
|
|
ERYTHROMYCIN 250 MG PO TABLET
|
Facility
|
IP
|
$72.77
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$61.85 |
| Max. Negotiated Rate |
$70.59 |
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Health Management Network Commercial |
$61.85
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.49
|
| Rate for Payer: MDX Hawaii PPO |
$70.59
|
|
|
ERYTHROMYCIN 250 MG PO TABLET
|
Facility
|
OP
|
$72.77
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$72.04 |
| Rate for Payer: AlohaCare Medicaid |
$36.38
|
| Rate for Payer: AlohaCare Medicare |
$65.49
|
| Rate for Payer: Cash Price |
$47.30
|
| Rate for Payer: Devoted Health Medicare |
$72.04
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$65.49
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$69.13
|
| Rate for Payer: Health Management Network Commercial |
$61.85
|
| Rate for Payer: Humana Medicare |
$65.49
|
| Rate for Payer: Kaiser Permanente Commercial |
$65.49
|
| Rate for Payer: Kaiser Permanente Medicaid |
$37.11
|
| Rate for Payer: Kaiser Permanente Medicare |
$65.49
|
| Rate for Payer: MDX Hawaii PPO |
$70.59
|
| Rate for Payer: Ohana Health Plan Medicaid |
$65.49
|
| Rate for Payer: Ohana Health Plan Medicare |
$65.49
|
| Rate for Payer: UnitedHealthcare Medicare |
$65.49
|
| Rate for Payer: University Health Alliance Commercial |
$53.04
|
|
|
ERYTHROMYCIN 5 MG/G OPHT OINT 1G UNIT DOSE TUBE
|
Facility
|
OP
|
$69.40
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$68.71 |
| Rate for Payer: AlohaCare Medicaid |
$34.70
|
| Rate for Payer: AlohaCare Medicare |
$62.46
|
| Rate for Payer: Cash Price |
$45.11
|
| Rate for Payer: Devoted Health Medicare |
$68.71
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$62.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$65.93
|
| Rate for Payer: Health Management Network Commercial |
$58.99
|
| Rate for Payer: Humana Medicare |
$62.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$35.39
|
| Rate for Payer: Kaiser Permanente Medicare |
$62.46
|
| Rate for Payer: MDX Hawaii PPO |
$67.32
|
| Rate for Payer: Ohana Health Plan Medicaid |
$62.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$62.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$62.46
|
| Rate for Payer: University Health Alliance Commercial |
$50.59
|
|
|
ERYTHROMYCIN 5 MG/G OPHT OINT 1G UNIT DOSE TUBE
|
Facility
|
IP
|
$69.40
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$58.99 |
| Max. Negotiated Rate |
$67.32 |
| Rate for Payer: Cash Price |
$45.11
|
| Rate for Payer: Health Management Network Commercial |
$58.99
|
| Rate for Payer: Kaiser Permanente Commercial |
$62.46
|
| Rate for Payer: MDX Hawaii PPO |
$67.32
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR (PER BOTTLE) WHR
|
Facility
|
OP
|
$1,050.68
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$525.34 |
| Max. Negotiated Rate |
$1,040.17 |
| Rate for Payer: AlohaCare Medicaid |
$525.34
|
| Rate for Payer: AlohaCare Medicaid |
$540.81
|
| Rate for Payer: AlohaCare Medicare |
$945.61
|
| Rate for Payer: AlohaCare Medicare |
$973.46
|
| Rate for Payer: Cash Price |
$703.05
|
| Rate for Payer: Cash Price |
$682.94
|
| Rate for Payer: Devoted Health Medicare |
$1,040.17
|
| Rate for Payer: Devoted Health Medicare |
$1,070.80
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$973.46
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$945.61
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$1,027.54
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$998.15
|
| Rate for Payer: Health Management Network Commercial |
$893.08
|
| Rate for Payer: Health Management Network Commercial |
$919.38
|
| Rate for Payer: Humana Medicare |
$973.46
|
| Rate for Payer: Humana Medicare |
$945.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$945.61
|
| Rate for Payer: Kaiser Permanente Commercial |
$973.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$551.63
|
| Rate for Payer: Kaiser Permanente Medicaid |
$535.85
|
| Rate for Payer: Kaiser Permanente Medicare |
$973.46
|
| Rate for Payer: Kaiser Permanente Medicare |
$945.61
|
| Rate for Payer: MDX Hawaii PPO |
$1,049.17
|
| Rate for Payer: MDX Hawaii PPO |
$1,019.16
|
| Rate for Payer: Ohana Health Plan Medicaid |
$945.61
|
| Rate for Payer: Ohana Health Plan Medicaid |
$973.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$945.61
|
| Rate for Payer: Ohana Health Plan Medicare |
$973.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$945.61
|
| Rate for Payer: UnitedHealthcare Medicare |
$973.46
|
| Rate for Payer: University Health Alliance Commercial |
$788.39
|
| Rate for Payer: University Health Alliance Commercial |
$765.84
|
|
|
ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML PO SUSR (PER BOTTLE) WHR
|
Facility
|
IP
|
$1,081.62
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$919.38 |
| Max. Negotiated Rate |
$1,049.17 |
| Rate for Payer: Cash Price |
$703.05
|
| Rate for Payer: Cash Price |
$682.94
|
| Rate for Payer: Health Management Network Commercial |
$919.38
|
| Rate for Payer: Health Management Network Commercial |
$893.08
|
| Rate for Payer: Kaiser Permanente Commercial |
$973.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$945.61
|
| Rate for Payer: MDX Hawaii PPO |
$1,019.16
|
| Rate for Payer: MDX Hawaii PPO |
$1,049.17
|
|
|
ESCITALOPRAM OXALATE 10 MG PO TABLET
|
Facility
|
OP
|
$23.85
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$23.61 |
| Rate for Payer: AlohaCare Medicaid |
$11.93
|
| Rate for Payer: AlohaCare Medicare |
$21.46
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Devoted Health Medicare |
$23.61
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$21.46
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$22.66
|
| Rate for Payer: Health Management Network Commercial |
$20.27
|
| Rate for Payer: Humana Medicare |
$21.46
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.46
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.16
|
| Rate for Payer: Kaiser Permanente Medicare |
$21.46
|
| Rate for Payer: MDX Hawaii PPO |
$23.13
|
| Rate for Payer: Ohana Health Plan Medicaid |
$21.46
|
| Rate for Payer: Ohana Health Plan Medicare |
$21.46
|
| Rate for Payer: UnitedHealthcare Medicare |
$21.46
|
| Rate for Payer: University Health Alliance Commercial |
$17.38
|
|
|
ESCITALOPRAM OXALATE 10 MG PO TABLET
|
Facility
|
IP
|
$23.85
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.27 |
| Max. Negotiated Rate |
$23.13 |
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Health Management Network Commercial |
$20.27
|
| Rate for Payer: Kaiser Permanente Commercial |
$21.46
|
| Rate for Payer: MDX Hawaii PPO |
$23.13
|
|
|
ESMOLOL IN NACL (ISO-OSM) 2500 MG/250 ML IV SOLP
|
Facility
|
OP
|
$471.48
|
|
|
Service Code
|
HCPCS J1805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$466.77 |
| Rate for Payer: AlohaCare Medicaid |
$235.74
|
| Rate for Payer: AlohaCare Medicare |
$424.33
|
| Rate for Payer: Cash Price |
$306.46
|
| Rate for Payer: Cash Price |
$306.46
|
| Rate for Payer: Devoted Health Medicare |
$466.77
|
| Rate for Payer: Hawaii Medical Service Association ABD |
$0.28
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$424.33
|
| Rate for Payer: Hawaii Medical Service Association Non-ABD |
$0.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$447.91
|
| Rate for Payer: Health Management Network Commercial |
$400.76
|
| Rate for Payer: Humana Medicare |
$424.33
|
| Rate for Payer: Kaiser Permanente Commercial |
$424.33
|
| Rate for Payer: Kaiser Permanente Medicaid |
$240.45
|
| Rate for Payer: Kaiser Permanente Medicare |
$424.33
|
| Rate for Payer: MDX Hawaii PPO |
$457.34
|
| Rate for Payer: Ohana Health Plan Medicaid |
$424.33
|
| Rate for Payer: Ohana Health Plan Medicare |
$424.33
|
| Rate for Payer: UnitedHealthcare Medicaid |
$282.89
|
| Rate for Payer: UnitedHealthcare Medicare |
$424.33
|
| Rate for Payer: University Health Alliance Commercial |
$343.66
|
|
|
ESMOLOL IN NACL (ISO-OSM) 2500 MG/250 ML IV SOLP
|
Facility
|
IP
|
$471.48
|
|
|
Service Code
|
HCPCS J1805
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$400.76 |
| Max. Negotiated Rate |
$457.34 |
| Rate for Payer: Cash Price |
$306.46
|
| Rate for Payer: Health Management Network Commercial |
$400.76
|
| Rate for Payer: Kaiser Permanente Commercial |
$424.33
|
| Rate for Payer: MDX Hawaii PPO |
$457.34
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$16,923.23
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$16,923.23 |
| Max. Negotiated Rate |
$16,923.23 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$16,923.23
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$14,553.03
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$14,553.03 |
| Max. Negotiated Rate |
$14,553.03 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$14,553.03
|
|
|
ESTRADIOL 0.5 MG PO TABLET
|
Facility
|
IP
|
$3.05
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.59 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Health Management Network Commercial |
$2.59
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.75
|
| Rate for Payer: MDX Hawaii PPO |
$2.96
|
|
|
ESTRADIOL 0.5 MG PO TABLET
|
Facility
|
OP
|
$3.05
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$3.02 |
| Rate for Payer: AlohaCare Medicaid |
$1.52
|
| Rate for Payer: AlohaCare Medicare |
$2.75
|
| Rate for Payer: Cash Price |
$1.98
|
| Rate for Payer: Devoted Health Medicare |
$3.02
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$2.75
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$2.90
|
| Rate for Payer: Health Management Network Commercial |
$2.59
|
| Rate for Payer: Humana Medicare |
$2.75
|
| Rate for Payer: Kaiser Permanente Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente Medicaid |
$1.56
|
| Rate for Payer: Kaiser Permanente Medicare |
$2.75
|
| Rate for Payer: MDX Hawaii PPO |
$2.96
|
| Rate for Payer: Ohana Health Plan Medicaid |
$2.75
|
| Rate for Payer: Ohana Health Plan Medicare |
$2.75
|
| Rate for Payer: UnitedHealthcare Medicare |
$2.75
|
| Rate for Payer: University Health Alliance Commercial |
$2.22
|
|
|
ETHAMBUTOL 400 MG PO TABLET
|
Facility
|
OP
|
$9.86
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.93 |
| Max. Negotiated Rate |
$9.76 |
| Rate for Payer: AlohaCare Medicaid |
$4.93
|
| Rate for Payer: AlohaCare Medicare |
$8.87
|
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Devoted Health Medicare |
$9.76
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$8.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$9.37
|
| Rate for Payer: Health Management Network Commercial |
$8.38
|
| Rate for Payer: Humana Medicare |
$8.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.87
|
| Rate for Payer: Kaiser Permanente Medicaid |
$5.03
|
| Rate for Payer: Kaiser Permanente Medicare |
$8.87
|
| Rate for Payer: MDX Hawaii PPO |
$9.56
|
| Rate for Payer: Ohana Health Plan Medicaid |
$8.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$8.87
|
| Rate for Payer: UnitedHealthcare Medicare |
$8.87
|
| Rate for Payer: University Health Alliance Commercial |
$7.19
|
|
|
ETHAMBUTOL 400 MG PO TABLET
|
Facility
|
IP
|
$9.86
|
|
|
Service Code
|
HCPCS A9270
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Cash Price |
$6.41
|
| Rate for Payer: Health Management Network Commercial |
$8.38
|
| Rate for Payer: Kaiser Permanente Commercial |
$8.87
|
| Rate for Payer: MDX Hawaii PPO |
$9.56
|
|
|
ETOMIDATE 2 MG/ML IV SOLN
|
Facility
|
OP
|
$24.51
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.26 |
| Max. Negotiated Rate |
$24.26 |
| Rate for Payer: AlohaCare Medicaid |
$12.26
|
| Rate for Payer: AlohaCare Medicaid |
$28.02
|
| Rate for Payer: AlohaCare Medicaid |
$11.04
|
| Rate for Payer: AlohaCare Medicare |
$50.43
|
| Rate for Payer: AlohaCare Medicare |
$22.06
|
| Rate for Payer: AlohaCare Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Devoted Health Medicare |
$55.47
|
| Rate for Payer: Devoted Health Medicare |
$24.26
|
| Rate for Payer: Devoted Health Medicare |
$21.86
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$50.43
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$22.06
|
| Rate for Payer: Hawaii Medical Service Association Medicare |
$19.87
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$20.98
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$23.28
|
| Rate for Payer: Hawaii Western Management Group Commercial |
$53.23
|
| Rate for Payer: Health Management Network Commercial |
$20.83
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Health Management Network Commercial |
$47.63
|
| Rate for Payer: Humana Medicare |
$19.87
|
| Rate for Payer: Humana Medicare |
$50.43
|
| Rate for Payer: Humana Medicare |
$22.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.43
|
| Rate for Payer: Kaiser Permanente Medicaid |
$28.58
|
| Rate for Payer: Kaiser Permanente Medicaid |
$11.26
|
| Rate for Payer: Kaiser Permanente Medicaid |
$12.50
|
| Rate for Payer: Kaiser Permanente Medicare |
$22.06
|
| Rate for Payer: Kaiser Permanente Medicare |
$19.87
|
| Rate for Payer: Kaiser Permanente Medicare |
$50.43
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
| Rate for Payer: MDX Hawaii PPO |
$54.35
|
| Rate for Payer: MDX Hawaii PPO |
$23.77
|
| Rate for Payer: Ohana Health Plan Medicaid |
$22.06
|
| Rate for Payer: Ohana Health Plan Medicaid |
$50.43
|
| Rate for Payer: Ohana Health Plan Medicaid |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$22.06
|
| Rate for Payer: Ohana Health Plan Medicare |
$19.87
|
| Rate for Payer: Ohana Health Plan Medicare |
$50.43
|
| Rate for Payer: UnitedHealthcare Medicaid |
$13.25
|
| Rate for Payer: UnitedHealthcare Medicaid |
$14.71
|
| Rate for Payer: UnitedHealthcare Medicaid |
$33.62
|
| Rate for Payer: UnitedHealthcare Medicare |
$22.06
|
| Rate for Payer: UnitedHealthcare Medicare |
$50.43
|
| Rate for Payer: UnitedHealthcare Medicare |
$19.87
|
| Rate for Payer: University Health Alliance Commercial |
$40.84
|
| Rate for Payer: University Health Alliance Commercial |
$16.09
|
| Rate for Payer: University Health Alliance Commercial |
$17.87
|
|
|
ETOMIDATE 2 MG/ML IV SOLN
|
Facility
|
IP
|
$56.03
|
|
|
Service Code
|
HCPCS J3490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$54.35 |
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$15.93
|
| Rate for Payer: Cash Price |
$14.35
|
| Rate for Payer: Health Management Network Commercial |
$47.63
|
| Rate for Payer: Health Management Network Commercial |
$18.77
|
| Rate for Payer: Health Management Network Commercial |
$20.83
|
| Rate for Payer: Kaiser Permanente Commercial |
$22.06
|
| Rate for Payer: Kaiser Permanente Commercial |
$19.87
|
| Rate for Payer: Kaiser Permanente Commercial |
$50.43
|
| Rate for Payer: MDX Hawaii PPO |
$21.42
|
| Rate for Payer: MDX Hawaii PPO |
$23.77
|
| Rate for Payer: MDX Hawaii PPO |
$54.35
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT
|
Facility
|
IP
|
$61,625.20
|
|
|
Service Code
|
MSDRG 933
|
| Min. Negotiated Rate |
$61,625.20 |
| Max. Negotiated Rate |
$61,625.20 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$61,625.20
|
|
|
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT
|
Facility
|
IP
|
$382,502.88
|
|
|
Service Code
|
MSDRG 927
|
| Min. Negotiated Rate |
$382,502.88 |
| Max. Negotiated Rate |
$382,502.88 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$382,502.88
|
|
|
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$45,650.05
|
|
|
Service Code
|
MSDRG 982
|
| Min. Negotiated Rate |
$45,650.05 |
| Max. Negotiated Rate |
$45,650.05 |
| Rate for Payer: Hawaii Medical Service Association Commercial |
$45,650.05
|
|
